Urban Michael Picard, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30.017754 Issued in OH

Practice address

15711 Madison Ave Ste 104
Lakewood, OH 44107-5655

Phone

(216) 228-9000

Fax

(216) 228-8280

NPI assigned

Jul 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407885601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15711 MADISON AVE STE 104",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441075655",
            "telephone_number": "216-228-9000",
            "fax_number": "216-228-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15711 MADISON AVE STE 104",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441075655",
            "telephone_number": "216-228-9000",
            "fax_number": "216-228-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICARD",
        "first_name": "URBAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.017754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0879581",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Victoria A Piskac, LICDC, LSW
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• Oral and Maxillofacial Surgery (Dentist) in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.