Provider Demographics
NPI:1104154376
Name:DR. JANICE I. BLOUGH-LABUDA, DMD, PA
Entity type:Organization
Organization Name:DR. JANICE I. BLOUGH-LABUDA, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BLOUGH-LABUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-724-2978
Mailing Address - Street 1:444 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7129
Mailing Address - Country:US
Mailing Address - Phone:301-724-2978
Mailing Address - Fax:301-724-6652
Practice Address - Street 1:444 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7129
Practice Address - Country:US
Practice Address - Phone:301-724-2978
Practice Address - Fax:301-724-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12554261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental