Healthcare Provider Details

I. General information

NPI: 1851504187
Provider Name (Legal Business Name): SALVATORE JOHN MANENTE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 3RD ST
NIAGARA FALLS NY
14301-1507
US

IV. Provider business mailing address

515 3RD ST
NIAGARA FALLS NY
14301-1507
US

V. Phone/Fax

Practice location:
  • Phone: 716-285-3588
  • Fax: 716-285-1083
Mailing address:
  • Phone: 716-285-3588
  • Fax: 716-285-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number043941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: