Healthcare Provider Details

I. General information

NPI: 1275459612
Provider Name (Legal Business Name): ROBERT ROSENBAUM DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MCHENRY AVE STE B
MODESTO CA
95350-3255
US

IV. Provider business mailing address

2200 MCHENRY AVE STE B
MODESTO CA
95350-3255
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-9132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ROSENBAUM
Title or Position: OWNER
Credential:
Phone: 209-526-9132