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General NPI Number Information
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NPI Number | 1265644744
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Entity Type | Organization
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Legal Business Name | FERNANDO A MARCHETTI DDS
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 1801 H STREET SUITE A7
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City | MODESTO
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State | CA
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Zip | 95354
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Country | US
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Telephone | 209-572-1722
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Fax | 209-491-2010
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Provider Business Mailing Address
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Address Line | 1801 H STREET SUITE A7
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City | MODESTO
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State | CA
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Zip | 95354
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Country | US
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Telephone | 209-572-1722
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Fax | 209-491-2010
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Authorized Official
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Title or Position | OWNER
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Name | DR. FERNANDO A MARCHETTI
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Credential | DDS, QME
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Telephone | 209-572-1739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33805
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License Number State | CA
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