Provider Demographics
NPI:1659598373
Name:PRATO, FAUSTO RENATO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAUSTO
Middle Name:RENATO
Last Name:PRATO
Suffix:
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 1:4255 PACIFIC AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-7638
Mailing Address - Country:US
Mailing Address - Phone:209-952-5454
Mailing Address - Fax:209-473-2634
Practice Address - Street 1:4255 PACIFIC AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-7638
Practice Address - Country:US
Practice Address - Phone:209-952-5454
Practice Address - Fax:209-473-2634
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice