1043403207 NPI number — ROBERT S JULIAN DDS MD INC

Table of content: (NPI 1043403207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043403207 NPI number — ROBERT S JULIAN DDS MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT S JULIAN DDS MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043403207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 N WAYTE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93701-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-459-4101
Provider Business Mailing Address Fax Number:
559-459-5744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 N WAYTE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93701-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-459-4101
Provider Business Practice Location Address Fax Number:
559-459-5744
Provider Enumeration Date:
08/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JULIAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
559-459-4101

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  36161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0106X , with the licence number: 36161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 36161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: A063394 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: A63994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0122X , with the licence number: A063994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: A063994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043403207 . This is a "MEDICARE - BILLING PROV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427119791 . This is a "MEDICARE - RENDERING/INDIVIDUAL PROV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 36161 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63994 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36161 . This is a "DENTAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B36161 . This is a "DENTI-CAL TX PROV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GA 1120 . This is a "GENERAL ANESTHESIA LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A063994 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B36161-01 . This is a "DENTI-CAL BILLING PROV." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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