Provider Demographics
NPI:1568875136
Name:OTO, MAGGIE LO (RDHAP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:LO
Last Name:OTO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 N POINT WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1083
Mailing Address - Country:US
Mailing Address - Phone:916-217-2450
Mailing Address - Fax:
Practice Address - Street 1:6403 N POINT WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-1083
Practice Address - Country:US
Practice Address - Phone:916-217-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 406124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist