Provider Demographics
NPI:1043403207
Name:ROBERT S JULIAN DDS MD INC
Entity Type:Organization
Organization Name:ROBERT S JULIAN DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:559-459-4101
Mailing Address - Street 1:290 N WAYTE LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2124
Mailing Address - Country:US
Mailing Address - Phone:559-459-4101
Mailing Address - Fax:559-459-5744
Practice Address - Street 1:290 N WAYTE LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-459-4101
Practice Address - Fax:559-459-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36161122300000X, 1223P0106X, 1223S0112X
CAA063394204E00000X
CAA63994204E00000X
CAA0639942086S0122X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043403207OtherMEDICARE - BILLING PROV
CA1427119791OtherMEDICARE - RENDERING/INDIVIDUAL PROV
CA36161Medicaid
CA63994Medicaid
CA36161OtherDENTAL LICENSE
CAB36161OtherDENTI-CAL TX PROV
CAGA 1120OtherGENERAL ANESTHESIA LIC
CAA063994OtherMEDICAL LICENSE
CAB36161-01OtherDENTI-CAL BILLING PROV.
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER
CAB36161-01OtherDENTI-CAL BILLING PROV.
CA36161Medicaid