Healthcare Provider Details

I. General information

NPI: 1760513782
Provider Name (Legal Business Name): FRED WILLIAM SALVATORIELLO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUMMER ST
HANOVER NH
03755-2121
US

IV. Provider business mailing address

38 E WHEELOCK ST PO BOX 181
HANOVER NH
03755-1515
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1415
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: