Provider Demographics
NPI:1033960562
Name:URBANICK, NICOLE ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:URBANICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24311 RIVARD CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2214
Mailing Address - Country:US
Mailing Address - Phone:734-308-4764
Mailing Address - Fax:
Practice Address - Street 1:1680 KINGSWAY CT STE 2
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1957
Practice Address - Country:US
Practice Address - Phone:734-676-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist