Provider Demographics
NPI:1205959798
Name:JAN S LABEDA D.D.S., INC
Entity type:Organization
Organization Name:JAN S LABEDA D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:STEFAN
Authorized Official - Last Name:LABEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-732-6660
Mailing Address - Street 1:4553 ELMONT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1008
Mailing Address - Country:US
Mailing Address - Phone:513-528-9553
Mailing Address - Fax:
Practice Address - Street 1:4553 ELMONT DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1008
Practice Address - Country:US
Practice Address - Phone:513-528-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental