Provider Demographics
NPI:1518215318
Name:LABLONDE, BRIAN PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:LABLONDE
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 1:235 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1148
Mailing Address - Country:US
Mailing Address - Phone:630-325-9298
Mailing Address - Fax:630-325-9299
Practice Address - Street 1:235 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1148
Practice Address - Country:US
Practice Address - Phone:630-325-9298
Practice Address - Fax:630-325-9299
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029188122300000X
IN12011833A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629172671OtherDORAL
IL364200988OtherTIN