1417073446 NPI number — ROBERT A. BOBIC DDS., INC

Table of content: (NPI 1417073446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417073446 NPI number — ROBERT A. BOBIC DDS., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT A. BOBIC DDS., 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:
AMERICAN DENTAL CARE
Provider Other Organization Name Type Code:
3
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:
1417073446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9849 ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE 'F'
Provider Business Mailing Address City Name:
SOUTH GATE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90280-5268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-564-7777
Provider Business Mailing Address Fax Number:
323-564-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9849 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE 'F'
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-5268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-7777
Provider Business Practice Location Address Fax Number:
323-564-7767
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOBIC
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-564-7777

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  20501 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07 20501 . This is a "DELTA DENTAL OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 20501 . This is a "DDS BOARD OF DEN EXAMINER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 06 20501 . This is a "DELTA DENTAL OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 771684 . This is a "UNITED CONCORDIA PROVIDE#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G 93244-01 . This is a "DENTICAL BILLING PROV#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G-93244-02 . This is a "DENTICAL BILLING PROV #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MO115936 . This is a "CALIF DL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1695206 . This is a "UNITED CONCORDIA ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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