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NPI Code Detail

MEDICARE: ULTRA DENTAL METRO LLC

MEDICARE: ULTRA DENTAL METRO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1063361038
Entity Type Code : Organization
Provider Name (Legal Business Name) : ULTRA DENTAL METRO LLC
Provider Business Mailing Address
First Line : 2938 E ROBIN LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-8420
Country : US
Telephone Number : 248-705-8334
Fax Number :
Provider Business Practice Location Address
First Line : 10621 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-4260
Country : US
Telephone Number : 248-705-8334
Fax Number :
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. BOBBY YASSO
Credential : DMD
Telephone Number : 248-705-8334
Provider Enumeration Date : 01/23/2026
Last Update Date : 01/23/2026

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