Individual
DERID URE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4601 50TH ST, SUITE 206, LUBBOCK, TX 79414-3513
(806) 792-8116
Mailing address
4601 50TH ST, SUITE 206, LUBBOCK, TX 79414-3513
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
25110
TX
Other
Enumeration date
12/17/2009
Last updated
12/17/2009
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