Provider Demographics
NPI:1669880399
Name:MAGTOTO, ALIDA GRACE M (DDS)
Entity type:Individual
Prefix:DR
First Name:ALIDA GRACE
Middle Name:M
Last Name:MAGTOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12316 PAWCATUCK WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7735
Mailing Address - Country:US
Mailing Address - Phone:916-753-9713
Mailing Address - Fax:
Practice Address - Street 1:10423 OLD PLACERVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2540
Practice Address - Country:US
Practice Address - Phone:916-822-8958
Practice Address - Fax:916-368-7945
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist