Provider Demographics
NPI:1477690915
Name:URATA, GILBERT LYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:LYLE
Last Name:URATA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:301 BROWNING AVE
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-0518
Mailing Address - Country:US
Mailing Address - Phone:907-424-7318
Mailing Address - Fax:
Practice Address - Street 1:301 BROWNING AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-0518
Practice Address - Country:US
Practice Address - Phone:907-424-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA0543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist