Provider Demographics
NPI:1073296463
Name:LAYTH, LAYTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAYTH
Middle Name:
Last Name:LAYTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 COMAL DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3319
Mailing Address - Country:US
Mailing Address - Phone:469-396-3856
Mailing Address - Fax:
Practice Address - Street 1:115 W SEMINARY DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-2603
Practice Address - Country:US
Practice Address - Phone:817-529-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice