Provider Demographics
NPI:1982659975
Name:LABRADA, ISMARI E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISMARI
Middle Name:E
Last Name:LABRADA
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 1:2200 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4502
Mailing Address - Country:US
Mailing Address - Phone:201-863-0426
Mailing Address - Fax:201-758-5566
Practice Address - Street 1:2200 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4502
Practice Address - Country:US
Practice Address - Phone:201-863-0426
Practice Address - Fax:201-758-5566
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022617001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0066443Medicaid