Provider Demographics
NPI:1770973091
Name:VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA
Entity type:Organization
Organization Name:VIVIANA P. URBAN,DDS, MICHAEL J. URBAN,DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-869-1170
Mailing Address - Street 1:101 LAKEFOREST BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2626
Mailing Address - Country:US
Mailing Address - Phone:301-869-1170
Mailing Address - Fax:301-869-0569
Practice Address - Street 1:101 LAKEFOREST BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2626
Practice Address - Country:US
Practice Address - Phone:301-869-1170
Practice Address - Fax:301-869-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty