Individual
DR. ROBERT S JULIAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
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.)
63994
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
A063994
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
A063994
CA
2086S0127X
Trauma Surgery Physician
A063994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043403207
MEDICARE - BILLING PROVIDER
CA
01
—
1427119791
MEDICARE - RENDERING/INDIVIDUAL PROV
CA
01
—
36161
DENTAL LICENSE
CA
05
—
63994
—
CA
01
—
A63994
MEDICAL LICENSE
CA
01
—
B36161
DENTICAL PROVIDER #
CA
01
—
GA 1120
GENERAL ANESTHESIA LIC
CA
Enumeration date
12/12/2006
Last updated
03/07/2023
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