Provider Demographics
NPI:1578146874
Name:LABRECQUE, AMBER (RDH)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2360
Mailing Address - Country:US
Mailing Address - Phone:413-885-0446
Mailing Address - Fax:
Practice Address - Street 1:103 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01022-1063
Practice Address - Country:US
Practice Address - Phone:413-593-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH89280124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist