Provider Demographics
NPI:1518649516
Name:STEPHANIE SANDRETTI, DDS AND MATTHEW SANDRETTI, DDS, MSD INC
Entity Type:Organization
Organization Name:STEPHANIE SANDRETTI, DDS AND MATTHEW SANDRETTI, DDS, MSD INC
Other - Org Name:SOUTHERN SMILES DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-479-3432
Mailing Address - Street 1:755 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-3705
Mailing Address - Country:US
Mailing Address - Phone:707-263-7023
Mailing Address - Fax:
Practice Address - Street 1:755 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-3705
Practice Address - Country:US
Practice Address - Phone:707-263-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental