Healthcare Provider Details

I. General information

NPI: 1770092017
Provider Name (Legal Business Name): LAYTH SARAF, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 PEMBROKE RD
GREENSBORO NC
27408-7901
US

IV. Provider business mailing address

100 VILLAGE CIRCLE WAY APT 832
DURHAM NC
27713-6136
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-6144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number10762
License Number StateNC

VIII. Authorized Official

Name: LAYTH SARAF
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 410-925-0933