Healthcare Provider Details

I. General information

NPI: 1235076894
Provider Name (Legal Business Name): LEYLAH COIMIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 W INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32114-1564
US

IV. Provider business mailing address

1890 NW 74TH WAY
HOLLYWOOD FL
33024-1064
US

V. Phone/Fax

Practice location:
  • Phone: 386-252-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: