Provider Demographics
NPI:1801201066
Name:URBINA FAMILY DENTAL
Entity Type:Organization
Organization Name:URBINA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MADELLE
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-834-8400
Mailing Address - Street 1:940 PAYTON GIN RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6720
Mailing Address - Country:US
Mailing Address - Phone:512-834-8400
Mailing Address - Fax:512-287-5326
Practice Address - Street 1:940 PAYTON GIN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6720
Practice Address - Country:US
Practice Address - Phone:512-834-8400
Practice Address - Fax:512-287-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty