Provider Demographics
NPI:1053549816
Name:URBANEK, DAVID E (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:URBANEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17300 OUTER FORTY ROAD NORTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:636-536-5158
Mailing Address - Fax:636-536-4544
Practice Address - Street 1:17300 OUTER FORTY ROAD NORTH
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005
Practice Address - Country:US
Practice Address - Phone:636-536-5158
Practice Address - Fax:636-536-4544
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0180017391223S0112X
MO20130078031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery