Provider Demographics
NPI:1396769733
Name:FRED W. SALVATORIELLO DMD PA
Entity type:Organization
Organization Name:FRED W. SALVATORIELLO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SALVATORIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-643-2170
Mailing Address - Street 1:3 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2121
Mailing Address - Country:US
Mailing Address - Phone:603-643-2170
Mailing Address - Fax:603-643-2176
Practice Address - Street 1:3 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2121
Practice Address - Country:US
Practice Address - Phone:603-643-2170
Practice Address - Fax:603-643-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00011651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191878Medicaid
VT0001878Medicaid