Provider Demographics
NPI:1497957849
Name:URGENTDENT
Entity Type:Organization
Organization Name:URGENTDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AJMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-513-0555
Mailing Address - Street 1:9352 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2810
Mailing Address - Country:US
Mailing Address - Phone:219-513-0555
Mailing Address - Fax:219-513-0666
Practice Address - Street 1:9352 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2810
Practice Address - Country:US
Practice Address - Phone:219-513-0555
Practice Address - Fax:219-513-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010375A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental