Healthcare Provider Details

I. General information

NPI: 1851679393
Provider Name (Legal Business Name): PETER URLING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S. FRANKLIN ST.
FARMINGTON MO
63640
US

IV. Provider business mailing address

19 S FRANKLIN ST
FARMINGTON MO
63640-2503
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-5781
  • Fax: 573-362-3389
Mailing address:
  • Phone: 573-883-5781
  • Fax: 573-362-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2011024084
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: