Provider Demographics
NPI:1720252349
Name:LABELLE, LEILANI L (DDS MS)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:L
Last Name:LABELLE
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD
Mailing Address - Street 2:#320
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:763-420-0200
Mailing Address - Fax:763-420-0204
Practice Address - Street 1:12000 ELM CREEK BLVD
Practice Address - Street 2:#320
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-420-0200
Practice Address - Fax:763-420-0204
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND99441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics