Provider Demographics
NPI:1386909422
Name:DAVOODY, LEYLA RIAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:RIAZ
Last Name:DAVOODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 O ST NW
Mailing Address - Street 2:APT 2B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4417
Mailing Address - Country:US
Mailing Address - Phone:301-655-5676
Mailing Address - Fax:
Practice Address - Street 1:1201 O ST NW
Practice Address - Street 2:APT 2B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4417
Practice Address - Country:US
Practice Address - Phone:301-655-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014147881223X0400X
MD157151223X0400X
DCDEN10014831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics