Healthcare Provider Details

I. General information

NPI: 1396477758
Provider Name (Legal Business Name): BRIDGET EDWAR FALTAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CORPORATE WAY # 150
SACRAMENTO CA
95831-3895
US

IV. Provider business mailing address

1102 CORPORATE WAY # 150
SACRAMENTO CA
95831-3895
US

V. Phone/Fax

Practice location:
  • Phone: 562-746-8706
  • Fax:
Mailing address:
  • Phone: 562-746-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10822
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number111205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: