Provider Demographics
NPI:1104825942
Name:LAYPORT, CYNTHIA A (DMD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:LAYPORT
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 1:15018 SW TELLURIDE TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6634
Mailing Address - Country:US
Mailing Address - Phone:503-646-6100
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD
Practice Address - Street 2:SUITE 230
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:503-620-1117
Practice Address - Fax:503-624-1547
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics