Provider Demographics
NPI:1033327325
Name:MADDERRA, GARRET S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRET
Middle Name:S
Last Name:MADDERRA
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 1:2020 HURLEY WAY
Mailing Address - Street 2:SUITE #290
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3223
Mailing Address - Country:US
Mailing Address - Phone:916-929-0969
Mailing Address - Fax:916-929-2243
Practice Address - Street 1:2020 HURLEY WAY
Practice Address - Street 2:SUITE #290
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3223
Practice Address - Country:US
Practice Address - Phone:916-929-0969
Practice Address - Fax:916-929-2243
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice