Provider Demographics
NPI:1255660460
Name:URE, DERID (DDS)
Entity Type:Individual
Prefix:
First Name:DERID
Middle Name:
Last Name:URE
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 1:4601 50TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3513
Practice Address - Country:US
Practice Address - Phone:806-792-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics