Provider Demographics
NPI:1114905569
Name:BLOUGH-LABUDA, JANICE IRENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:IRENE
Last Name:BLOUGH-LABUDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7129
Mailing Address - Country:US
Mailing Address - Phone:301-724-2978
Mailing Address - Fax:301-724-6652
Practice Address - Street 1:444 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7129
Practice Address - Country:US
Practice Address - Phone:301-724-2978
Practice Address - Fax:301-724-6652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD811203OtherUCCI PROV. NUMBER