Provider Demographics
NPI:1598839607
Name:URBAN, AMY DIANNE (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DIANNE
Last Name:URBAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 S. CONGRESS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-440-5900
Mailing Address - Fax:512-440-5901
Practice Address - Street 1:3801 S. CONGRESS AVE.
Practice Address - Street 2:STE 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-440-5900
Practice Address - Fax:512-440-5901
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX201061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice