Individual
IDA HAZEEM-LAYOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
600 NE 8TH ST, GRESHAM, OR 97030-7317
(503) 553-9249
Mailing address
600 NE 8TH ST, GRESHAM, OR 97030-7317
(503) 553-9249
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9872
OR
Other
Enumeration date
06/07/2013
Last updated
11/03/2014
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