Healthcare Provider Details

I. General information

NPI: 1053845743
Provider Name (Legal Business Name): ROBERT J BROSI, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49414 ROAD 426
OAKHURST CA
93644-9701
US

IV. Provider business mailing address

PO BOX 2407
OAKHURST CA
93644-2407
US

V. Phone/Fax

Practice location:
  • Phone: 559-683-4694
  • Fax: 559-642-6219
Mailing address:
  • Phone: 559-683-4694
  • Fax: 559-642-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number29875
License Number StateCA

VIII. Authorized Official

Name: ROBERT J BROSI
Title or Position: DENTIST
Credential: DDS
Phone: 559-683-4694