Provider Demographics
NPI:1821124603
Name:MARIA ESPERANZA LABAO DDS INC
Entity Type:Organization
Organization Name:MARIA ESPERANZA LABAO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ESPERANZA
Authorized Official - Last Name:LABAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-873-6798
Mailing Address - Street 1:1590 EL CAMINO REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-873-6798
Mailing Address - Fax:650-873-6643
Practice Address - Street 1:1590 EL CAMINO REAL
Practice Address - Street 2:SUITE A
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-873-6798
Practice Address - Fax:650-873-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4685301OtherDENTI CAL