Healthcare Provider Details

I. General information

NPI: 1881156164
Provider Name (Legal Business Name): ELIZABETH LABORDE DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 EDWARDS RANCH RD
FORT WORTH TX
76109
US

IV. Provider business mailing address

321 N BAILEY AVE
FORT WORTH TX
76107-1001
US

V. Phone/Fax

Practice location:
  • Phone: 214-226-8732
  • Fax:
Mailing address:
  • Phone: 214-226-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ELIZABETH LABORDE
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: DDS
Phone: 214-226-8732