Provider Demographics
NPI:1356567606
Name:URBAN M. PICARD DDS, INC
Entity type:Organization
Organization Name:URBAN M. PICARD DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:URBAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-228-9000
Mailing Address - Street 1:15711 MADISON AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:216-228-9000
Mailing Address - Fax:216-228-8280
Practice Address - Street 1:15711 MADISON AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-228-9000
Practice Address - Fax:216-228-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0177541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879581Medicaid
OH0879581Medicaid