Provider Demographics
NPI:1063859916
Name:SANDRETTI, STEPHANIE LYN CAPPIELLO (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYN CAPPIELLO
Last Name:SANDRETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GIBSON DR STE 190
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5796
Mailing Address - Country:US
Mailing Address - Phone:916-532-1635
Mailing Address - Fax:916-404-4074
Practice Address - Street 1:9296 VINTAGE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1625
Practice Address - Country:US
Practice Address - Phone:916-532-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice