Provider Demographics
NPI:1497480263
Name:JAVID, LAILI (DDS)
Entity Type:Individual
Prefix:
First Name:LAILI
Middle Name:
Last Name:JAVID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 EL CAMINO REAL STE 280
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3803
Mailing Address - Country:US
Mailing Address - Phone:650-562-0590
Mailing Address - Fax:
Practice Address - Street 1:3301 EL CAMINO REAL STE 280
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3803
Practice Address - Country:US
Practice Address - Phone:650-562-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39658122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist