Provider Demographics
NPI:1952319980
Name:LABOSKY, KEVIN PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PETER
Last Name:LABOSKY
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 1:133 KAYWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827
Mailing Address - Country:US
Mailing Address - Phone:814-466-6929
Mailing Address - Fax:
Practice Address - Street 1:474 WINDMERE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-237-7004
Practice Address - Fax:814-237-7024
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030241L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist