Provider Demographics
NPI:1649656877
Name:ROBERT C. URQUHART DDS, PC
Entity type:Organization
Organization Name:ROBERT C. URQUHART DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:URQUHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-554-2575
Mailing Address - Street 1:8400 OSUNA RD NE
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2087
Mailing Address - Country:US
Mailing Address - Phone:505-554-2575
Mailing Address - Fax:505-835-5136
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 4-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2087
Practice Address - Country:US
Practice Address - Phone:505-554-2575
Practice Address - Fax:505-835-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD25931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77439279Medicaid