Healthcare Provider Details

I. General information

NPI: 1912499567
Provider Name (Legal Business Name): ISAAC URLING DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22717 S ELLSWORTH RD STE B102
QUEEN CREEK AZ
85142
US

IV. Provider business mailing address

835 N GRANITE REEF RD UNIT 32
SCOTTSDALE AZ
85257-4579
US

V. Phone/Fax

Practice location:
  • Phone: 480-888-9596
  • Fax:
Mailing address:
  • Phone: 928-243-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9999
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009999
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: