Provider Demographics
NPI:1619075645
Name:LABRITZ, CAROLINE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:G
Last Name:LABRITZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 HOLLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4209
Mailing Address - Country:US
Mailing Address - Phone:304-296-3786
Mailing Address - Fax:304-292-5925
Practice Address - Street 1:406 HOLLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-4209
Practice Address - Country:US
Practice Address - Phone:304-296-3786
Practice Address - Fax:304-292-5925
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003350OtherWV DENTAL MEDICAL CARD