Healthcare Provider Details

I. General information

NPI: 1184082018
Provider Name (Legal Business Name): SANDRA CONTTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA TREJOS DDS

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CYPRESS POINT PKWY A3
PALM COAST FL
32164
US

IV. Provider business mailing address

50 CYPRESS POINT PKWY A3
PALM COAST FL
32164
US

V. Phone/Fax

Practice location:
  • Phone: 386-445-0977
  • Fax:
Mailing address:
  • Phone: 386-626-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22989
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22989
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: