Provider Demographics
NPI:1689876245
Name:LABUWI, ROBIN S (DMD,)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:S
Last Name:LABUWI
Suffix:
Gender:M
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1971
Mailing Address - Country:US
Mailing Address - Phone:618-439-4366
Mailing Address - Fax:
Practice Address - Street 1:405 E PARK ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1971
Practice Address - Country:US
Practice Address - Phone:618-439-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice