Provider Demographics
NPI: | 1447655600 |
---|---|
Name: | PLANET ORAL HEALTHCARE |
Entity type: | Organization |
Organization Name: | PLANET ORAL HEALTHCARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LABBE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 909-496-0277 |
Mailing Address - Street 1: | 31480 CONCORD DR |
Mailing Address - Street 2: | # F |
Mailing Address - City: | MADISON HEIGHTS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48071-1731 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 216-835-1165 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1400 GUADALUPE ST |
Practice Address - Street 2: | |
Practice Address - City: | LAREDO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78040-5315 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-568-5537 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-30 |
Last Update Date: | 2014-10-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 30571 | 1223X0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223X0400X | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | Group - Multi-Specialty |