Provider Demographics
NPI:1245883669
Name:LABELLE, CODY JAMES (DMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
Last Name:LABELLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 CARAMBOLA CIR S
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2925
Mailing Address - Country:US
Mailing Address - Phone:828-551-7184
Mailing Address - Fax:
Practice Address - Street 1:440 S STATE ROAD 7 STE 100
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414-4414
Practice Address - Country:US
Practice Address - Phone:561-753-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist