Healthcare Provider Details

I. General information

NPI: 1942352208
Provider Name (Legal Business Name): EDWARD JOSEPH URIG JR. DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL DR
SANTA FE NM
87505
US

IV. Provider business mailing address

1700 HOSPITAL DR
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2121
  • Fax: 505-988-3160
Mailing address:
  • Phone: 505-988-2121
  • Fax: 505-988-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD1576
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: