Provider Demographics
NPI:1922129667
Name:YULY VILDERMAN PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:YULY VILDERMAN PROFESSIONAL DENTAL CORPORATION
Other - Org Name:METRO DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YULY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-567-2900
Mailing Address - Street 1:2233 POST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3444
Mailing Address - Country:US
Mailing Address - Phone:415-567-2900
Mailing Address - Fax:415-567-0193
Practice Address - Street 1:2233 POST ST
Practice Address - Street 2:STE 102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3470
Practice Address - Country:US
Practice Address - Phone:415-567-2900
Practice Address - Fax:415-567-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty