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General NPI Number Information
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NPI Number | 1770973091
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Entity Type | Organization
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Legal Business Name | VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 101 LAKEFOREST BLVD STE 101B
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2626
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Country | US
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Telephone | 301-869-1170
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Fax | 301-869-0569
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Provider Business Mailing Address
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Address Line | 101 LAKEFOREST BLVD STE 101B
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2626
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Country | US
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Telephone | 301-869-1170
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Fax | 301-869-0569
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Authorized Official
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Title or Position | VICE PRESIDENT/OWNER DENTIST
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Name | DR. VIVIANA P. URBAN
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Credential | DDS
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Telephone | 301-869-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10446
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License Number State | MD
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