Individual provider Active NPI

Robert F Dufresne, DDS

  • Dentist
  • Sacramento, CA
National Provider Identifier
1336604727
Registry record updated Nov 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
103416 Issued in CA
Practice address
6339 Mack Rd
Sacramento, CA 95823-4655
Phone
(916) 454-2345
Fax
(916) 457-2667
NPI assigned
Feb 10, 2019
Last updated
Nov 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 103416 CA Primary

Addresses

Primary practice location

6339 Mack Rd
Sacramento, CA 95823-4655

Mailing address

3710 P St
Sacramento, CA 95816-6733
Phone (315) 404-9223

Other names 1

  • Robert F Ash Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230410002213 CA Order and Referring Only - DentistPractitioner - Dentist 0648645473

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
103416CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700870400000",
    "number": "1336604727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 P ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958166733",
            "telephone_number": "315-404-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6339 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234655",
            "telephone_number": "916-454-2345",
            "fax_number": "916-457-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFRESNE",
        "first_name": "ROBERT",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-10",
        "last_updated": "2023-11-25",
        "certification_date": "2023-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERT",
            "last_name": "ASH",
            "middle_name": "F",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.