Provider Demographics
NPI:1497935431
Name:SCOTT D URBAN DMD MD PC
Entity Type:Organization
Organization Name:SCOTT D URBAN DMD MD PC
Other - Org Name:UTAH FACIAL SURGICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-282-5363
Mailing Address - Street 1:7611 JORDAN LANDING BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5610
Mailing Address - Country:US
Mailing Address - Phone:801-282-5363
Mailing Address - Fax:801-282-5360
Practice Address - Street 1:7611 JORDAN LANDING BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5610
Practice Address - Country:US
Practice Address - Phone:801-282-5363
Practice Address - Fax:801-282-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5315516261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528912530001Medicaid