Provider Demographics
NPI:1487862280
Name:GARRET MADDERRA DDS, LP
Entity Type:Organization
Organization Name:GARRET MADDERRA DDS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAVETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:916-929-0969
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
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
Practice Address - Country:US
Practice Address - Phone:916-929-0969
Practice Address - Fax:916-929-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty