Provider Demographics
NPI:1295270189
Name:SALERNO, GRACE (RDH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SALERNO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:ROSSIGNOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:CODE J-1001 BUILDING 277
Mailing Address - Street 2:NORFOLK NAVAL SHIPYARD BRANCH DENTAL CLINIC
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23709-1001
Mailing Address - Country:US
Mailing Address - Phone:757-953-6509
Mailing Address - Fax:
Practice Address - Street 1:CODE J-1001 BUILDING 277
Practice Address - Street 2:NORFOLK NAVAL SHIPYARD BRANCH DENTAL CLINIC
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23709-1001
Practice Address - Country:US
Practice Address - Phone:757-953-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008318124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist