Provider Demographics
NPI:1679455935
Name:URBAN DMD AND URBAN DMD PLLC
Entity type:Organization
Organization Name:URBAN DMD AND URBAN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-642-5817
Mailing Address - Street 1:182 YELLOW BIRCH LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W CROSSTIE LN
Practice Address - Street 2:#110
Practice Address - City:TROUTMAN
Practice Address - State:NC
Practice Address - Zip Code:28166
Practice Address - Country:US
Practice Address - Phone:704-980-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417377573OtherDENTIST