Provider Demographics
NPI:1164041307
Name:BAHRANI, LAYA (DDS)
Entity Type:Individual
Prefix:
First Name:LAYA
Middle Name:
Last Name:BAHRANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAYA
Other - Middle Name:MOHAMED
Other - Last Name:AL BAHRANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1406 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8960 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2870
Practice Address - Country:US
Practice Address - Phone:307-509-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.002047691223G0001X
CO00204769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice