Provider Demographics
NPI:1730255480
Name:LABBERTON, WELLS KURT (DDS)
Entity type:Individual
Prefix:DR
First Name:WELLS
Middle Name:KURT
Last Name:LABBERTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 TIETON DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-965-4209
Mailing Address - Fax:509-965-5583
Practice Address - Street 1:4209 TIETON DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-965-4209
Practice Address - Fax:509-965-5583
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA28481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0393OtherWDS
0098114OtherLI
5003173OtherDSHS