Provider Demographics
NPI:1578957973
Name:LABARRE, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LABARRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W MAPLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4406
Mailing Address - Country:US
Mailing Address - Phone:248-932-8980
Mailing Address - Fax:248-419-6124
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-932-8980
Practice Address - Fax:248-419-6124
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016906124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist