Provider Demographics
NPI:1053797308
Name:AL KAISSY, LAYTH KAREEM (DMD)
Entity type:Individual
Prefix:DR
First Name:LAYTH
Middle Name:KAREEM
Last Name:AL KAISSY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4917
Mailing Address - Country:US
Mailing Address - Phone:817-926-6677
Mailing Address - Fax:817-926-6679
Practice Address - Street 1:4351 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4917
Practice Address - Country:US
Practice Address - Phone:832-814-2777
Practice Address - Fax:817-926-6679
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39134122300000X
MADN18570171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice