Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 20501 | CA |
NPI | 1013004621 |
---|---|
Provider Name | Robert M Bobic |
First Address | Upland, CA 91786 |
Second Address | Upland, CA 91786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |