Provider Demographics
NPI:1679630420
Name:URBAN, VIVIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:
Last Name:URBAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAKEFOREST BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2626
Mailing Address - Country:US
Mailing Address - Phone:301-869-1170
Mailing Address - Fax:301-869-0569
Practice Address - Street 1:101 LAKEFOREST BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2626
Practice Address - Country:US
Practice Address - Phone:301-869-1170
Practice Address - Fax:301-869-0569
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist