Provider Demographics
NPI:1659543445
Name:LABORDE, ELIZABETH LEDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEDDY
Last Name:LABORDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:321 N BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1001
Mailing Address - Country:US
Mailing Address - Phone:214-226-8732
Mailing Address - Fax:
Practice Address - Street 1:134 EL CHICO TRL
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8861
Practice Address - Country:US
Practice Address - Phone:817-441-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist