Healthcare Provider Details

I. General information

NPI: 1023026002
Provider Name (Legal Business Name): EDWARD WILLIAM URBINA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32920 ROAD 140
VISALIA CA
93292-9318
US

IV. Provider business mailing address

32920 ROAD 140
VISALIA CA
93292-9318
US

V. Phone/Fax

Practice location:
  • Phone: 559-284-3050
  • Fax: 559-635-9383
Mailing address:
  • Phone: 559-284-3050
  • Fax: 559-635-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: