Provider Demographics
NPI:1619211885
Name:ANTELOPE VALLEY ORAL SURGERY, DENTAL GROUP OF GREGORY R. URFRIG, DMD A
Entity Type:Organization
Organization Name:ANTELOPE VALLEY ORAL SURGERY, DENTAL GROUP OF GREGORY R. URFRIG, DMD A
Other - Org Name:ANTELOPE VALLEY ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:URFRIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-945-4040
Mailing Address - Street 1:44439 17TH ST W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2831
Mailing Address - Country:US
Mailing Address - Phone:661-945-4040
Mailing Address - Fax:661-945-9120
Practice Address - Street 1:44439 17TH ST W
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2831
Practice Address - Country:US
Practice Address - Phone:661-945-4040
Practice Address - Fax:661-945-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54374204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty