Provider Demographics
NPI:1942403993
Name:URSU, SAMUEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:URSU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31815 SOUTHFIELD ROAD
Mailing Address - Street 2:MEDICAL VILLAGE 15
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-646-7234
Mailing Address - Fax:248-646-0253
Practice Address - Street 1:31815 SOUTHFIELD ROAD
Practice Address - Street 2:MEDICAL VILLAGE 15
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-646-7234
Practice Address - Fax:248-646-0253
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI75651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice