Provider Demographics
NPI:1427119791
Name:JULIAN, ROBERT S III (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:JULIAN
Suffix:III
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36161122300000X, 1223P0106X, 1223S0112X
CA63994204E00000X
CAA0639942086S0122X, 2086S0127X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427119791OtherMEDICARE - RENDERING/INDIVIDUAL PROV
CA36161OtherDENTAL LICENSE
CA63994Medicaid
CA1043403207OtherMEDICARE - BILLING PROVIDER
CAB36161OtherDENTICAL PROVIDER #
CAA63994OtherMEDICAL LICENSE
CAGA 1120OtherGENERAL ANESTHESIA LIC
CAGA 1120OtherGENERAL ANESTHESIA LIC
CAA63994OtherMEDICAL LICENSE
CAA63994OtherMEDICAL LICENSE