Provider Demographics
NPI:1417073446
Name:ROBERT A. BOBIC DDS., INC
Entity Type:Organization
Organization Name:ROBERT A. BOBIC DDS., INC
Other - Org Name:AMERICAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BOBIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-564-7777
Mailing Address - Street 1:9849 ATLANTIC AVE
Mailing Address - Street 2:SUITE 'F'
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5268
Mailing Address - Country:US
Mailing Address - Phone:323-564-7777
Mailing Address - Fax:323-564-7767
Practice Address - Street 1:9849 ATLANTIC AVE
Practice Address - Street 2:SUITE 'F'
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-5268
Practice Address - Country:US
Practice Address - Phone:323-564-7777
Practice Address - Fax:323-564-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07 20501OtherDELTA DENTAL OF CA
CA20501OtherDDS BOARD OF DEN EXAMINER
CA06 20501OtherDELTA DENTAL OF CA
PA771684OtherUNITED CONCORDIA PROVIDE#
CAG 93244-01OtherDENTICAL BILLING PROV#
CAG-93244-02OtherDENTICAL BILLING PROV #
CAMO115936OtherCALIF DL
PA1695206OtherUNITED CONCORDIA ID#