Dr. Robert C. Chisholm, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

22331 Issued in CA

Legal business name

DR. ROBERT C. CHISHOLM, DDS

Practice address

36640 Fremont Blvd
Suite a
Fremont, CA 94536-3630

Phone

(510) 792-8844

Fax

(510) 792-1334

NPI assigned

Apr 21, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Breanna Masuda, DA

Title

Office Manager

Phone

(510) 792-8844

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1508286253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36640 FREMONT BLVD",
            "address_2": "SUITE A",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363630",
            "telephone_number": "510-792-8844",
            "fax_number": "510-792-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36640 FREMONT BLVD",
            "address_2": "SUITE A",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363630",
            "telephone_number": "510-792-8844",
            "fax_number": "510-792-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ROBERT C. CHISHOLM, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "MASUDA",
        "authorized_official_first_name": "BREANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "510-792-8844",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "22331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fremont, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.