Provider Demographics
NPI:1386844785
Name:CODY, SARA ELIZABETH LEONETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH LEONETTE
Last Name:CODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 RYAN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7985
Mailing Address - Country:US
Mailing Address - Phone:715-386-5400
Mailing Address - Fax:
Practice Address - Street 1:744 RYAN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7979
Practice Address - Country:US
Practice Address - Phone:715-386-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227151223G0001X
WI6035-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice