Provider Demographics
NPI:1689921991
Name:LABUDA, JAYNE KELLY (DMD)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:KELLY
Last Name:LABUDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 HARTLEY BRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-4116
Mailing Address - Country:US
Mailing Address - Phone:478-621-7657
Mailing Address - Fax:
Practice Address - Street 1:4226 HARTLEY BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-4116
Practice Address - Country:US
Practice Address - Phone:478-621-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice