Provider Demographics
NPI:1538547518
Name:SALLES, ALESSANDRA PAIVA (LLD)
Entity type:Individual
Prefix:MRS
First Name:ALESSANDRA
Middle Name:PAIVA
Last Name:SALLES
Suffix:
Gender:F
Credentials:LLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CONNORS ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2637
Mailing Address - Country:US
Mailing Address - Phone:978-410-6100
Mailing Address - Fax:978-410-6176
Practice Address - Street 1:175 CONNORS ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2637
Practice Address - Country:US
Practice Address - Phone:978-410-6100
Practice Address - Fax:978-410-6176
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL125151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice