Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 018001739 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2013007803 | MO |
NPI | 1053549816 |
---|---|
Provider Name | Dr. David E. Urbanek |
First Address | Chesterfield, MO 63005 |
Second Address | Chesterfield, MO 63005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 14/08/2014 |