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General NPI Number Information
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NPI Number | 1295828697
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Entity Type | Individual
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Provider Name | ANTHONY E URLAKIS JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 N MAIN ST
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City | JANESVILLE
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State | WI
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Zip | 53545
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Country | US
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Telephone | 608-754-6852
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Fax | 608-314-1178
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Provider Business Mailing Address
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Address Line | 111 N MAIN ST
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City | JANESVILLE
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State | WI
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Zip | 53545
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Country | US
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Telephone | 608-754-6852
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Fax | 608-314-1178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5000576015
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License Number State | WI
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