Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901022105 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 13193 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901022105 | MI |
NPI | 1104819101 |
---|---|
Provider Name | Dr. John Paul Labanc |
First Address | Marietta, GA 30068-5518 |
Second Address | Marietta, GA 30068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 07/06/2018 |