Provider Demographics
NPI:1871614818
Name:JENIFER B LABRADOR DDS INC
Entity type:Organization
Organization Name:JENIFER B LABRADOR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:LABRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-835-9010
Mailing Address - Street 1:22211 S AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-835-9010
Mailing Address - Fax:310-835-3044
Practice Address - Street 1:22211 S AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-835-9010
Practice Address - Fax:310-835-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42840122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty