Provider Demographics
NPI:1609391218
Name:MENTA DENTAL
Entity type:Organization
Organization Name:MENTA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LABBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-242-0223
Mailing Address - Street 1:2395 E DEL MAR BLVD UNIT 452069
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0185
Mailing Address - Country:US
Mailing Address - Phone:214-864-7292
Mailing Address - Fax:
Practice Address - Street 1:1211 E DEL MAR BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2406
Practice Address - Country:US
Practice Address - Phone:956-242-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty