Healthcare Provider Details

I. General information

NPI: 1831227693
Provider Name (Legal Business Name): KEVIN JOHN URBANEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 DOWNTOWNER PLZ
COSHOCTON OH
43812-1924
US

IV. Provider business mailing address

2567 ARBOR PARK
NEWARK OH
43055-7056
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-4421
  • Fax:
Mailing address:
  • Phone: 740-587-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: