Healthcare Provider Details

I. General information

NPI: 1770899486
Provider Name (Legal Business Name): RICHARD FRANCIS URBANCZYK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W LINCOLN AVE
MILWAUKEE WI
53227-1255
US

IV. Provider business mailing address

10401 W LINCOLN AVE
MILWAUKEE WI
53227-1255
US

V. Phone/Fax

Practice location:
  • Phone: 414-546-1900
  • Fax:
Mailing address:
  • Phone: 414-546-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5534-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: