Basic Information
| Provider Information | |||||||||
| NPI: | 1538547518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALLES | ||||||||
| FirstName: | ALESSANDRA | ||||||||
| MiddleName: | PAIVA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 CONNORS ST | ||||||||
| Address2: | |||||||||
| City: | GARDNER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014402637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784106100 | ||||||||
| FaxNumber: | 9784106176 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 CONNORS ST | ||||||||
| Address2: | |||||||||
| City: | GARDNER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014402637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784106100 | ||||||||
| FaxNumber: | 9784106176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2015 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DL12515 | MA | Y | Dental Providers | Dentist | General Practice |
No ID Information.