Healthcare Provider Details

I. General information

NPI: 1841896149
Provider Name (Legal Business Name): LAYLA DAOUDI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BROADWAY ST
HOUSTON TX
77087-4713
US

IV. Provider business mailing address

8812 LAKESHORE TERRACE DR
HOUSTON TX
77080-6030
US

V. Phone/Fax

Practice location:
  • Phone: 713-645-1680
  • Fax:
Mailing address:
  • Phone: 972-310-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: