Provider Demographics
NPI:1750389367
Name:URBAN, SCOTT DIETER (DMD,MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DIETER
Last Name:URBAN
Suffix:
Gender:M
Credentials:DMD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7532 S CENTER VIEW CT STE 102
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5547
Mailing Address - Country:US
Mailing Address - Phone:801-282-5363
Mailing Address - Fax:801-282-5360
Practice Address - Street 1:7532 S CENTER VIEW CT STE 102
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5547
Practice Address - Country:US
Practice Address - Phone:801-282-5363
Practice Address - Fax:801-282-5360
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5315516-9924204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH62760Medicare UPIN