Provider Demographics
NPI:1710001391
Name:TRENTALANCIA, SALVATORE (DDS)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:TRENTALANCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N MAIN ST
Mailing Address - Street 2:REFUA HEALTH CENTER
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1960
Mailing Address - Country:US
Mailing Address - Phone:845-354-9300
Mailing Address - Fax:845-354-4298
Practice Address - Street 1:728 N MAIN ST
Practice Address - Street 2:REFUAH HEALTH CENTER
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1960
Practice Address - Country:US
Practice Address - Phone:845-354-9300
Practice Address - Fax:845-354-4298
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid