Leilani L Labelle, DDS MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D9944 Issued in MN

Practice address

12000 Elm Creek Blvd
#320
Maple Grove, MN 55369

Phone

(763) 420-0200

Fax

(763) 420-0204

NPI assigned

Apr 15, 2008

Last updated

Apr 15, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 16, 2021 through Aug 16, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wang Periodontics PLLC

  dba Maple Grove Periodontics and Implant Dentistry

  • Periodontics
  • Maple Grove, MN
  • NPI 1093442048
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208217600000",
    "number": "1720252349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD",
            "address_2": "#320",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-420-0200",
            "fax_number": "763-420-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD",
            "address_2": "#320",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-420-0200",
            "fax_number": "763-420-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABELLE",
        "first_name": "LEILANI",
        "middle_name": "L",
        "credential": "DDS MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D9944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiera Taylor Kutzke
• Alysha Kvam
• Leeann Rae Kyriakides, M.S. CCC SLP, COM
• L.C. Optometric P.C.
• L&C Health Solutions LLC
• Heather Lynn Labere, M.D.
• Brian Glenn Labine, MD
• Jennifer Renae Lafond, CNP
• Venetia Laganis, D.D.S., M.S.
• Heather Lage, RN, CDE

• Periodontics in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.