Healthcare Provider Details

I. General information

NPI: 1053549816
Provider Name (Legal Business Name): DAVID E. URBANEK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 OUTER FORTY ROAD NORTH SUITE 103
CHESTERFIELD MO
63005
US

IV. Provider business mailing address

17300 OUTER FORTY ROAD NORTH SUITE 103
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5158
  • Fax: 636-536-4544
Mailing address:
  • Phone: 636-536-5158
  • Fax: 636-536-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number018001739
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2013007803
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: