Provider Demographics
NPI:1962446195
Name:LORD, LEYLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:LORD
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 1:4509 E LANCASTER AVE
Mailing Address - Street 2:APT. 5211
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3210
Mailing Address - Country:US
Mailing Address - Phone:817-546-1020
Mailing Address - Fax:817-546-1024
Practice Address - Street 1:4509 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3210
Practice Address - Country:US
Practice Address - Phone:817-546-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220281223X0400X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177615501Medicaid