Provider Demographics
NPI:1497022131
Name:DERID S. URE, DDS, MSD, PA
Entity Type:Organization
Organization Name:DERID S. URE, DDS, MSD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERID
Authorized Official - Middle Name:
Authorized Official - Last Name:URE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-792-8116
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25110261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental