MEDICARE: YULY VILDERMAN PROFESSIONAL DENTAL CORPORATION

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
1	1223G0001X	General Practice Dentistry	41689	CA

General Provider Information

NPI Number	:	1922129667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YULY VILDERMAN PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2233 POST ST STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3444
Country	:	US
Telephone Number	:	415-567-2900
Fax Number	:	415-567-0193

Provider Business Practice Location Address
First Line	:	2233 POST ST
Second Line	:	STE 102
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3470
Country	:	US
Telephone Number	:	415-567-2900
Fax Number	:	415-567-0193

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YULY VILDERMAN
Credential	:	DDS
Telephone Number	:	415-567-2900

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	05/28/2021

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