Provider Demographics
NPI:1811030679
Name:LIVRERI, SALVATORE JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOHN
Last Name:LIVRERI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 ASHWYCKE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7091
Mailing Address - Country:US
Mailing Address - Phone:843-884-5858
Mailing Address - Fax:843-884-9550
Practice Address - Street 1:3478 ASHWYCKE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7091
Practice Address - Country:US
Practice Address - Phone:843-884-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics