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Organization
LORD DENTAL, P.A.
Active
Organization
LORD DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEYLA LORD D.M.D. (PRESIDENT)
(972) 904-9248
Entity
Organization
Contact information
Practice address
4509 E LANCASTER AVE, FORT WORTH, TX 76103-3210
(817) 546-1020
Mailing address
4509 E LANCASTER AVE, FORT WORTH, TX 76103-3210
(817) 546-1020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22028
TX
1223G0001X
General Practice Dentistry
Primary
22028
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
22028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177614801
—
TX
01
—
B2202801
CHIP
TX
Enumeration date
11/28/2006
Last updated
05/11/2016
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