Healthcare Provider Details

I. General information

NPI: 1114003464
Provider Name (Legal Business Name): DAVID W. URBAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PARK AVE #305
FALLS CHURCH VA
22046-3303
US

IV. Provider business mailing address

313 PARK AVE #305
FALLS CHURCH VA
22046-3303
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-1712
  • Fax: 703-536-0283
Mailing address:
  • Phone: 703-532-1712
  • Fax: 703-536-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401-005804
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: