Healthcare Provider Details

I. General information

NPI: 1497963904
Provider Name (Legal Business Name): VLADIMIR GUDICH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 GEARY BLVD
SAN FRANCISCO CA
94118-3004
US

IV. Provider business mailing address

4312 GEARY BLVD
SAN FRANCISCO CA
94118-3004
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-5605
  • Fax: 415-752-8597
Mailing address:
  • Phone: 415-752-5605
  • Fax: 415-752-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: