Provider Demographics
NPI:1215419809
Name:MAGGASS, GREGORY ARLEN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ARLEN
Last Name:MAGGASS
Suffix:JR
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 1:4222 7TH AVE NE APT 8
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6086
Mailing Address - Country:US
Mailing Address - Phone:602-206-5201
Mailing Address - Fax:
Practice Address - Street 1:4222 7TH AVE NE APT 8
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6086
Practice Address - Country:US
Practice Address - Phone:602-206-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608821601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice