Healthcare Provider Details

I. General information

NPI: 1255102117
Provider Name (Legal Business Name): MATTHEW SANDRETTI DDS MSD DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W OLIVE AVE STE 102
MERCED CA
95348-2436
US

IV. Provider business mailing address

5101 KENNETH AVE
FAIR OAKS CA
95628-5331
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-3776
  • Fax:
Mailing address:
  • Phone: 916-479-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW SANDRRETTI
Title or Position: OWNER
Credential: DDS
Phone: 916-479-3432