Provider Demographics
NPI:1194278945
Name:YALDO, ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:YALDO
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 1:36700 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0930
Mailing Address - Country:US
Mailing Address - Phone:248-290-2900
Mailing Address - Fax:
Practice Address - Street 1:36700 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0930
Practice Address - Country:US
Practice Address - Phone:248-290-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010218821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice