Provider Demographics
NPI:1750947180
Name:URBAN DENTAL PCS
Entity type:Organization
Organization Name:URBAN DENTAL PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-957-0849
Mailing Address - Street 1:2451 FH 1103
Mailing Address - Street 2:#109
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108
Mailing Address - Country:US
Mailing Address - Phone:210-957-0849
Mailing Address - Fax:210-519-3044
Practice Address - Street 1:2451 FH 1103
Practice Address - Street 2:#109
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108
Practice Address - Country:US
Practice Address - Phone:210-957-0849
Practice Address - Fax:210-519-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty