Provider Demographics
NPI:1144340555
Name:BARUT, ROBERTO I (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:I
Last Name:BARUT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N. CAMINO ALTO
Mailing Address - Street 2:#204
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2563
Mailing Address - Country:US
Mailing Address - Phone:707-644-7945
Mailing Address - Fax:707-644-1513
Practice Address - Street 1:1460 N CAMINO ALTO
Practice Address - Street 2:#204
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-644-7945
Practice Address - Fax:707-644-1513
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB322441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice