Provider Demographics
NPI:1750909180
Name:SALVINO, BALEIGH AUTUMN (DDS)
Entity type:Individual
Prefix:DR
First Name:BALEIGH
Middle Name:AUTUMN
Last Name:SALVINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BALEIGH
Other - Middle Name:AUTUMN
Other - Last Name:DEITRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:145 GLENMORA DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0317
Mailing Address - Country:US
Mailing Address - Phone:574-721-5793
Mailing Address - Fax:
Practice Address - Street 1:101 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4229
Practice Address - Country:US
Practice Address - Phone:630-323-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist