Provider Demographics
NPI:1265644744
Name:FERNANDO A MARCHETTI DDS
Entity Type:Organization
Organization Name:FERNANDO A MARCHETTI DDS
Other - Org Name:ARC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, QME
Authorized Official - Phone:209-572-1739
Mailing Address - Street 1:1801 H STREET
Mailing Address - Street 2:SUITE A7
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354
Mailing Address - Country:US
Mailing Address - Phone:209-572-1722
Mailing Address - Fax:209-491-2010
Practice Address - Street 1:1801 H STREET
Practice Address - Street 2:SUITE A7
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354
Practice Address - Country:US
Practice Address - Phone:209-572-1722
Practice Address - Fax:209-491-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33805OtherLICENSE NUMBER
CAB33805-01Medicaid
CAB33805-01Medicaid