Provider Demographics
NPI:1164292801
Name:UR DENTAL, PLLC
Entity Type:Organization
Organization Name:UR DENTAL, PLLC
Other - Org Name:URE FAMILY DENTIST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:URE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-682-4516
Mailing Address - Street 1:102 ALABAMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2518
Mailing Address - Country:US
Mailing Address - Phone:850-682-4516
Mailing Address - Fax:
Practice Address - Street 1:102 ALABAMA ST STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2518
Practice Address - Country:US
Practice Address - Phone:850-682-4516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty