Provider Demographics
NPI:1407885601
Name:PICARD, URBAN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:URBAN
Middle Name:MICHAEL
Last Name:PICARD
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 1:15711 MADISON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:216-228-9000
Mailing Address - Fax:216-228-8280
Practice Address - Street 1:15711 MADISON AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-228-9000
Practice Address - Fax:216-228-8280
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0177541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879581Medicaid
OH0879581Medicaid