Provider Demographics
NPI:1922092055
Name:REDELSPERGER, ROBERT JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JACOB
Last Name:REDELSPERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3711
Mailing Address - Country:US
Mailing Address - Phone:661-324-6053
Mailing Address - Fax:661-324-2640
Practice Address - Street 1:2106 20TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3711
Practice Address - Country:US
Practice Address - Phone:661-324-6053
Practice Address - Fax:661-324-2640
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist