# GLENN W. LABINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477848828
- **Authorized official:** TERRI CARLSON (RECEPTIONIST)
- **Authorized official phone:** (701) 775-0682

## Contact information

- **Practice address:** 2401 S WASHINGTON ST, SUITE C, GRAND FORKS, ND 58201-6747
- **Practice address phone:** (701) 775-0682
- **Practice address fax:** (701) 772-9697
- **Mailing address:** 2401 S WASHINGTON ST, SUITE C, GRAND FORKS, ND 58201-6747
- **Mailing address phone:** (701) 775-0682
- **Mailing address fax:** (701) 772-9697

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1535 | ND | Yes |

## Other

- **Enumeration date:** 06/14/2011
- **Last updated:** 06/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40572 | — | ND |
| 05 | — | 451220100 | — | MN |