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General NPI Number Information
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NPI Number | 1104154376
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Entity Type | Organization
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Legal Business Name | DR. JANICE I. BLOUGH-LABUDA, DMD, PA
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 444 NATIONAL HWY
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City | LAVALE
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State | MD
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Zip | 21502-7129
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Country | US
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Telephone | 301-724-2978
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Fax | 301-724-6652
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Provider Business Mailing Address
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Address Line | 444 NATIONAL HWY
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City | LAVALE
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State | MD
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Zip | 21502-7129
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Country | US
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Telephone | 301-724-2978
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Fax | 301-724-6652
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JANICE IRENE BLOUGH-LABUDA
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Credential | DMD
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Telephone | 301-724-2978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12554
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License Number State | MD
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