Provider Demographics
NPI:1053044875
Name:SIGNATURE DENTAL LLC
Entity Type:Organization
Organization Name:SIGNATURE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LABBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-269-1343
Mailing Address - Street 1:26 S COUNTY COMMONS WAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8273
Mailing Address - Country:US
Mailing Address - Phone:401-284-3308
Mailing Address - Fax:401-284-3667
Practice Address - Street 1:26 S COUNTY COMMONS WAY UNIT D
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-8273
Practice Address - Country:US
Practice Address - Phone:401-284-3308
Practice Address - Fax:401-284-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental