Provider Demographics
NPI:1912069873
Name:RIZVI, LAILA H (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:H
Last Name:RIZVI
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 1:3708 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5869
Mailing Address - Country:US
Mailing Address - Phone:407-240-3372
Mailing Address - Fax:407-240-3660
Practice Address - Street 1:3708 TOWN CENTER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5869
Practice Address - Country:US
Practice Address - Phone:407-240-3372
Practice Address - Fax:407-240-3660
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice