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Organization

ROBERT S JULIAN DDS MD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT S JULIAN III D.D.S., M.D. (PRESIDENT/OWNER)
(559) 459-4101
Entity
Organization

Contact information

Practice address
290 N WAYTE LN, FRESNO, CA 93701-2124
(559) 459-4101
(559) 459-5744
Mailing address
290 N WAYTE LN, FRESNO, CA 93701-2124
(559) 459-4101
(559) 459-5744

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
36161
CA
1223P0106X
Oral and Maxillofacial Pathology Dentistry
36161
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
36161
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
A063394
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
A63994
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
A063994
CA
2086S0127X
Trauma Surgery Physician
A063994
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
$$$$$$$$$
SOCIAL SECURITY NUMBER
CA
01
1043403207
MEDICARE - BILLING PROV
CA
01
1427119791
MEDICARE - RENDERING/INDIVIDUAL PROV
CA
01
36161
DENTAL LICENSE
CA
05
36161
CA
05
63994
CA
01
A063994
MEDICAL LICENSE
CA
01
B36161
DENTI-CAL TX PROV
CA
01
B36161-01
DENTI-CAL BILLING PROV.
CA
01
GA 1120
GENERAL ANESTHESIA LIC
CA
Enumeration date
08/21/2007
Last updated
03/07/2023
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