Provider Demographics
NPI:1619021425
Name:FRAUSTO, DAVID JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:FRAUSTO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:FRAUSTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7136 PAV WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2264
Mailing Address - Country:US
Mailing Address - Phone:928-775-9495
Mailing Address - Fax:928-775-9497
Practice Address - Street 1:7136 PAV WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2264
Practice Address - Country:US
Practice Address - Phone:928-775-9495
Practice Address - Fax:928-775-9497
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist