Provider Demographics
NPI:1346964210
Name:GATMAITAN, RHEANNE MADISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:RHEANNE
Middle Name:MADISON
Last Name:GATMAITAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E DEL MAR BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3613
Mailing Address - Country:US
Mailing Address - Phone:484-557-1028
Mailing Address - Fax:
Practice Address - Street 1:8678 19TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-4559
Practice Address - Country:US
Practice Address - Phone:909-257-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist