Provider Demographics
NPI:1154443778
Name:URBANSKI, THEODORE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:URBANSKI
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 1:1254 IRVINE BLVD
Mailing Address - Street 2:140
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3509
Mailing Address - Country:US
Mailing Address - Phone:714-838-4611
Mailing Address - Fax:714-838-3190
Practice Address - Street 1:1254 IRVINE BLVD
Practice Address - Street 2:140
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3509
Practice Address - Country:US
Practice Address - Phone:714-838-4611
Practice Address - Fax:714-838-3190
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice