Provider Demographics
NPI:1104347327
Name:URBAN, SANDRA STEPHANY (DDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:STEPHANY
Last Name:URBAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:STEPHANY
Other - Last Name:DELGADO-QUEZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5701 BALD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4451
Mailing Address - Country:US
Mailing Address - Phone:505-917-5309
Mailing Address - Fax:
Practice Address - Street 1:4431 68TH ST
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5042
Practice Address - Country:US
Practice Address - Phone:505-917-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice