MEDICARE: DR. NATHANIEL URQUHART DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D5580	AZ

General Provider Information

NPI Number	:	1760427967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL URQUHART DMD

Provider Business Mailing Address
First Line	:	2195 E PACKARD AVE
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-1211
Country	:	US
Telephone Number	:	928-388-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 N STOCKTON HILL RD STE A
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6601
Country	:	US
Telephone Number	:	928-718-8668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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