Provider Demographics
NPI:1902947435
Name:MATTHEW CARDINALLI A DENTAL CORP
Entity type:Organization
Organization Name:MATTHEW CARDINALLI A DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CARDINALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-478-7898
Mailing Address - Street 1:4255 PACIFIC AVE
Mailing Address - Street 2:14
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-478-7898
Mailing Address - Fax:209-473-2634
Practice Address - Street 1:4255 PACIFIC AVE
Practice Address - Street 2:14
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-478-7898
Practice Address - Fax:209-473-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty