Provider Demographics
NPI:1568626851
Name:ULLOA, BRAULIO YEZID (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAULIO
Middle Name:YEZID
Last Name:ULLOA
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 1:2480 MISSION ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-643-1105
Mailing Address - Fax:415-643-1107
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-643-1105
Practice Address - Fax:415-643-1107
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice