Provider Demographics
NPI:1225160716
Name:VILDERMAN, ALEXANDER (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:VILDERMAN
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 1:4130 TRUXEL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3760
Mailing Address - Country:US
Mailing Address - Phone:916-285-9400
Mailing Address - Fax:916-285-8636
Practice Address - Street 1:4130 TRUXEL RD
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3760
Practice Address - Country:US
Practice Address - Phone:916-285-9400
Practice Address - Fax:916-285-8636
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice