Provider Demographics
NPI:1508276460
Name:SANDRETTI, MATTHEW AUGUST (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AUGUST
Last Name:SANDRETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2264
Mailing Address - Country:US
Mailing Address - Phone:916-768-8144
Mailing Address - Fax:
Practice Address - Street 1:9727 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2264
Practice Address - Country:US
Practice Address - Phone:916-768-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04420001941223X0400X
CA645221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics