NPIMap

Organization Active NPI

Steven J Urback DDS Magd PS

  • General Practice Dentistry
  • Puyallup, WA
National Provider Identifier
1114045804
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5496 Issued in WA
Legal business name
STEVEN J URBACK DDS MAGD PS
Practice address
2921 5TH Ave NE
Suite 110
Puyallup, WA 98372-7044
Phone
(253) 841-3173
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lauren Gideon
Title
Office Manager
Phone
(253) 841-3173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5496 WA Primary

Addresses

Primary practice location

2921 5TH Ave NE
Suite 110
Puyallup, WA 98372-7044

Mailing address

2921 5TH Ave NE
Suite 110
Puyallup, WA 98372-7044
Phone (253) 841-3173

Other identifiers 1

IdentifierTypeStateIssuer
5047048MedicaidWA

Other names 1

  • Puyallup Valley Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

2921 5th Ave NE
Ste 110
Puyallup, WA 98372
Phone (253) 200-5553

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1114045804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 5TH AVE NE",
            "address_2": "SUITE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727044",
            "telephone_number": "253-841-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 5TH AVE NE",
            "address_2": "SUITE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727044",
            "telephone_number": "253-841-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN J URBACK DDS MAGD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "GIDEON",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-841-3173"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "5496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5047048",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puyallup Valley Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.