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General NPI Number Information
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NPI Number | 1669880399
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Entity Type | Individual
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Provider Name | ALIDA GRACE M MAGTOTO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 10423 OLD PLACERVILLE RD STE A
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City | SACRAMENTO
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State | CA
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Zip | 95827-2540
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Country | US
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Telephone | 916-822-8958
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Fax | 916-368-7945
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Provider Business Mailing Address
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Address Line | 12316 PAWCATUCK WAY
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City | RANCHO CORDOVA
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State | CA
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Zip | 95742-7735
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Country | US
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Telephone | 916-753-9713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63731
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License Number State | CA
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