Healthcare Provider Details

I. General information

NPI: 1699696708
Provider Name (Legal Business Name): FAUSTINA GRACE FRATTALI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 WILKINSON BLVD UNIT B2
CHARLOTTE NC
28208-5662
US

IV. Provider business mailing address

14339 PERUGIA WAY APT 301
CHARLOTTE NC
28273-7242
US

V. Phone/Fax

Practice location:
  • Phone: 704-900-5445
  • Fax:
Mailing address:
  • Phone: 585-967-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11482
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14915
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: