Provider Demographics
NPI:1609304252
Name:GHOLAMI, LAYA (DDS, MSD, MS)
Entity type:Individual
Prefix:DR
First Name:LAYA
Middle Name:
Last Name:GHOLAMI
Suffix:
Gender:F
Credentials:DDS, MSD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1487
Mailing Address - Country:US
Mailing Address - Phone:214-830-0118
Mailing Address - Fax:
Practice Address - Street 1:517 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5408
Practice Address - Country:US
Practice Address - Phone:214-830-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN232191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty