Healthcare Provider Details

I. General information

NPI: 1356431415
Provider Name (Legal Business Name): ROGER DAVID URLAUB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 RAVEN RIDGE RD SUITE 115
RALEIGH NC
27614-6487
US

IV. Provider business mailing address

10941 RAVEN RIDGE RD SUITE 115
RALEIGH NC
27614-6487
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-1201
  • Fax: 919-532-0306
Mailing address:
  • Phone: 919-870-1201
  • Fax: 919-532-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: