Healthcare Provider Details

I. General information

NPI: 1396769733
Provider Name (Legal Business Name): FRED W. SALVATORIELLO DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUMMER ST
HANOVER NH
03755-2121
US

IV. Provider business mailing address

3 SUMMER ST
HANOVER NH
03755-2121
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-2170
  • Fax: 603-643-2176
Mailing address:
  • Phone: 603-643-2170
  • Fax: 603-643-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number016-0001165
License Number StateVT

VIII. Authorized Official

Name: DR. FRED WILLIAM SALVATORIELLO
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-643-2170