Provider Demographics
NPI:1679617609
Name:URBACK, STEVEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:URBACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2921 5TH AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7044
Mailing Address - Country:US
Mailing Address - Phone:253-841-3173
Mailing Address - Fax:253-841-0210
Practice Address - Street 1:2921 5TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7044
Practice Address - Country:US
Practice Address - Phone:253-841-3173
Practice Address - Fax:253-841-0210
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047048Medicaid