Healthcare Provider Details

I. General information

NPI: 1396130068
Provider Name (Legal Business Name): LAITH MAHMOOD DDS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GESSNER RD SUITE 690
HOUSTON TX
77024-2527
US

IV. Provider business mailing address

915 GESSNER RD SUITE 690
HOUSTON TX
77024-2527
US

V. Phone/Fax

Practice location:
  • Phone: 713-467-5655
  • Fax: 713-467-9221
Mailing address:
  • Phone: 713-467-5655
  • Fax: 713-467-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number28554
License Number StateTX

VIII. Authorized Official

Name: DR. LAITH MAHMOOD
Title or Position: ORAL SURGEON/OWNER
Credential: DDS
Phone: 713-467-5655