Organization
GLENN W. LABINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI CARLSON (RECEPTIONIST)
(701) 775-0682
Entity
Organization
Contact information
Practice address
2401 S WASHINGTON ST, SUITE C, GRAND FORKS, ND 58201-6747
(701) 775-0682
(701) 772-9697
Mailing address
2401 S WASHINGTON ST, SUITE C, GRAND FORKS, ND 58201-6747
(701) 775-0682
(701) 772-9697
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1535
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40572
—
ND
05
—
451220100
—
MN
Enumeration date
06/14/2011
Last updated
06/14/2011
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