1659543445 NPI number — DR. ELIZABETH LEDDY LABORDE DDS

Table of content: DR. ELIZABETH LEDDY LABORDE DDS (NPI 1659543445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659543445 NPI number — DR. ELIZABETH LEDDY LABORDE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABORDE
Provider First Name:
ELIZABETH
Provider Middle Name:
LEDDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEDDY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659543445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N BAILEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76107-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-226-8732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 EL CHICO TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLOW PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76087-8861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-441-2425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  27722 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)