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General NPI Number Information
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NPI Number | 1477848828
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Entity Type | Organization
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Legal Business Name | GLENN W. LABINE
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 2401 S WASHINGTON ST SUITE C
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City | GRAND FORKS
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State | ND
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Zip | 58201-6747
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Country | US
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Telephone | 701-775-0682
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Fax | 701-772-9697
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Provider Business Mailing Address
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Address Line | 2401 S WASHINGTON ST SUITE C
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City | GRAND FORKS
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State | ND
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Zip | 58201-6747
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Country | US
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Telephone | 701-775-0682
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Fax | 701-772-9697
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | TERRI CARLSON
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Credential |
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Telephone | 701-775-0682
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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 | 1535
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License Number State | ND
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