Provider Demographics
NPI:1053845743
Name:ROBERT J BROSI, DDS, INC.
Entity Type:Organization
Organization Name:ROBERT J BROSI, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-683-4694
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-2407
Mailing Address - Country:US
Mailing Address - Phone:559-683-4694
Mailing Address - Fax:559-642-6219
Practice Address - Street 1:49414 ROAD 426
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9701
Practice Address - Country:US
Practice Address - Phone:559-683-4694
Practice Address - Fax:559-642-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29875332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies