MEDICARE: DR. RICHARD A. URBANEK JR. DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19611	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1374885	OTHER	TX	UNITED CONCORDIA ID

General Provider Information

NPI Number	:	1568576882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A. URBANEK JR. DDS, MS

Provider Business Mailing Address
First Line	:	5 EUREKA CIR
Second Line	:	SUITE B
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2900
Country	:	US
Telephone Number	:	940-696-2002
Fax Number	:	940-696-2006

Provider Business Practice Location Address
First Line	:	5 EUREKA CIR
Second Line	:	SUITE B
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2900
Country	:	US
Telephone Number	:	940-696-2002
Fax Number	:	940-696-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/08/2007

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