Healthcare Provider Details

I. General information

NPI: 1043403207
Provider Name (Legal Business Name): ROBERT S JULIAN DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN
FRESNO CA
93701-2124
US

IV. Provider business mailing address

290 N WAYTE LN
FRESNO CA
93701-2124
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4101
  • Fax: 559-459-5744
Mailing address:
  • Phone: 559-459-4101
  • Fax: 559-459-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number36161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number36161
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number36161
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA063394
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA063994
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA063994
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA63994
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT S JULIAN III
Title or Position: PRESIDENT/OWNER
Credential: D.D.S., M.D.
Phone: 559-459-4101