MEDICARE: DR. LEYLA LORD D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22028	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22028	TX
3	1223G0001X	General Practice Dentistry	22028	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962446195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEYLA LORD D.M.D.

Provider Business Mailing Address
First Line	:	4509 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3210
Country	:	US
Telephone Number	:	817-546-1020
Fax Number	:	817-546-1024

Provider Business Practice Location Address
First Line	:	4509 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3210
Country	:	US
Telephone Number	:	817-546-1020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	06/12/2024

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Directions to “ DR. LEYLA LORD D.M.D.” Practice Location

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