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General NPI Number Information
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NPI Number | 1164577557
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Entity Type | Individual
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Provider Name | CHARLES FRANK LABAS JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 698 MAIN ST
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City | WATERTOWN
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State | CT
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Zip | 06795-2614
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Country | US
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Telephone | 860-945-9265
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Fax | 860-945-9265
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Provider Business Mailing Address
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Address Line | 698 MAIN ST P.O.BOX235
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City | WATERTOWN
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State | CT
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Zip | 06795-2614
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Country | US
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Telephone | 860-945-9265
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Fax | 860-945-9265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5622
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License Number State | CT
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