1104006014 NPI number — URBAN DENTAL, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104006014 NPI number — URBAN DENTAL, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URBAN DENTAL, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104006014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9933 LAWLER AVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-677-7820
Provider Business Mailing Address Fax Number:
847-677-7822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9933 LAWLER AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-677-7820
Provider Business Practice Location Address Fax Number:
847-677-7822
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
URBAN
Authorized Official First Name:
VERONIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-677-7820

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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