Provider Demographics
NPI:1790809218
Name:MONCADA, FAUSTO R (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAUSTO
Middle Name:R
Last Name:MONCADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2400 WESTBOROUGH BLVD
Mailing Address - Street 2:STE. 204
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5404
Mailing Address - Country:US
Mailing Address - Phone:650-588-0288
Mailing Address - Fax:650-588-0584
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5404
Practice Address - Country:US
Practice Address - Phone:650-588-0288
Practice Address - Fax:650-588-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA338121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics