Provider Demographics
NPI:1053446245
Name:MAGTOTO, MICHAEL (DMD, MMSC, DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MAGTOTO
Suffix:
Gender:M
Credentials:DMD, MMSC, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 J ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3331
Mailing Address - Country:US
Mailing Address - Phone:857-222-7552
Mailing Address - Fax:510-471-2513
Practice Address - Street 1:1203 J ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3331
Practice Address - Country:US
Practice Address - Phone:857-222-7552
Practice Address - Fax:510-471-2513
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist