Provider Demographics
NPI:1043624034
Name:LABERGE, BRIEANNE M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIEANNE
Middle Name:M
Last Name:LABERGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-0126
Mailing Address - Country:US
Mailing Address - Phone:608-643-3855
Mailing Address - Fax:608-643-6295
Practice Address - Street 1:464 WATER ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1127
Practice Address - Country:US
Practice Address - Phone:608-643-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI727215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist