Provider Demographics
NPI:1073722724
Name:LABUDDE, PETER CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHRISTIAN
Last Name:LABUDDE
Suffix:
Gender:M
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 404
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037
Mailing Address - Country:US
Mailing Address - Phone:262-677-2224
Mailing Address - Fax:262-677-3620
Practice Address - Street 1:N168 W20566 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037
Practice Address - Country:US
Practice Address - Phone:262-677-2224
Practice Address - Fax:262-677-3620
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice