1770973091 NPI number — VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA

Table of content: (NPI 1770973091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770973091 NPI number — VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA
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:
1770973091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 LAKEFOREST BLVD STE 101B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20877-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-869-1170
Provider Business Mailing Address Fax Number:
301-869-0569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 LAKEFOREST BLVD STE 101B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-869-1170
Provider Business Practice Location Address Fax Number:
301-869-0569
Provider Enumeration Date:
01/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
URBAN
Authorized Official First Name:
VIVIANA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
VICE PRESIDENT/OWNER DENTIST
Authorized Official Telephone Number:
301-869-1170

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10446 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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