Provider Demographics
NPI:1477295509
Name:LABE, BRANDON JOSHUA (DMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSHUA
Last Name:LABE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 15TH ST APT 1102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1518
Mailing Address - Country:US
Mailing Address - Phone:408-466-9111
Mailing Address - Fax:
Practice Address - Street 1:4320 OSAGE BEACH PKWY STE A
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-0500
Practice Address - Country:US
Practice Address - Phone:408-466-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230090181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice