Healthcare Provider Details

I. General information

NPI: 1700248523
Provider Name (Legal Business Name): LEILAH BAISDEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19961 KATY FWY
HOUSTON TX
77094-1019
US

IV. Provider business mailing address

2536 AMHERST ST STE A
HOUSTON TX
77005-3207
US

V. Phone/Fax

Practice location:
  • Phone: 713-244-7799
  • Fax:
Mailing address:
  • Phone: 713-490-8880
  • Fax: 713-490-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6693
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36046
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: