Provider Demographics
NPI:1659571255
Name:LABOUNTY DENTAL, INC.
Entity Type:Organization
Organization Name:LABOUNTY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-303-7930
Mailing Address - Street 1:1951 ARTESIA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2985
Mailing Address - Country:US
Mailing Address - Phone:310-303-7930
Mailing Address - Fax:
Practice Address - Street 1:1951 ARTESIA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2985
Practice Address - Country:US
Practice Address - Phone:310-303-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty