Provider Demographics
NPI:1679589493
Name:KEVIN P LABOSKY DMD LLC
Entity type:Organization
Organization Name:KEVIN P LABOSKY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LABOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-237-7004
Mailing Address - Street 1:474 WINDMERE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-237-7004
Mailing Address - Fax:814-237-7024
Practice Address - Street 1:474 WINDMERE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-237-7004
Practice Address - Fax:814-237-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS03024IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty