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General NPI Number Information
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NPI Number | 1255102117
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Entity Type | Organization
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Legal Business Name | MATTHEW SANDRETTI DDS MSD DENTAL CORP
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 750 W OLIVE AVE STE 102
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City | MERCED
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State | CA
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Zip | 95348-2436
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Country | US
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Telephone | 209-723-3776
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 KENNETH AVE
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City | FAIR OAKS
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State | CA
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Zip | 95628-5331
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Country | US
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Telephone | 916-479-3432
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW SANDRRETTI
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Credential | DDS
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Telephone | 916-479-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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