Provider Demographics
NPI:1093749251
Name:ROBERT A. ROSENBAUM, DDS, INC.
Entity Type:Organization
Organization Name:ROBERT A. ROSENBAUM, DDS, INC.
Other - Org Name:DR. ROSENBAUM AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-526-9132
Mailing Address - Street 1:2200 MCHENRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3255
Mailing Address - Country:US
Mailing Address - Phone:209-526-9132
Mailing Address - Fax:209-526-9131
Practice Address - Street 1:2200 MCHENRY AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3255
Practice Address - Country:US
Practice Address - Phone:209-526-9132
Practice Address - Fax:209-526-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty