Healthcare Provider Details

I. General information

NPI: 1285658476
Provider Name (Legal Business Name): ROBERT J. LABREL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAIN ST
FORT BENTON MT
59442-0338
US

IV. Provider business mailing address

1220 MAIN ST BOX 338
FORT BENTON MT
59442-0338
US

V. Phone/Fax

Practice location:
  • Phone: 406-622-3651
  • Fax: 406-622-3651
Mailing address:
  • Phone: 406-622-3651
  • Fax: 406-622-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1487
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: