1124037908 NPI number — DR. LLOYD LEE LAUGHLIN D.D.S., P.A.

Table of content: DR. LLOYD LEE LAUGHLIN D.D.S., P.A. (NPI 1124037908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124037908 NPI number — DR. LLOYD LEE LAUGHLIN D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUGHLIN
Provider First Name:
LLOYD
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124037908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/15/2023
NPI Reactivation Date:
01/03/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 E SAM HOUSTON PKWY S STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77505-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-998-4916
Provider Business Mailing Address Fax Number:
281-998-4839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 FAIRMONT PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-998-4916
Provider Business Practice Location Address Fax Number:
281-998-4839
Provider Enumeration Date:
08/07/2006

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: 1223G0001X , with the licence number:  18132 , 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)





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