Healthcare Provider Details

I. General information

NPI: 1871744276
Provider Name (Legal Business Name): MARTIN ANDREW URBAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 OTIS ST
WESTBOROUGH MA
01581-3315
US

IV. Provider business mailing address

76 OTIS ST
WESTBOROUGH MA
01581-3315
US

V. Phone/Fax

Practice location:
  • Phone: 508-870-1911
  • Fax:
Mailing address:
  • Phone: 508-870-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: