Provider Demographics
NPI:1376564096
Name:FARIAS, DELAINE ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELAINE
Middle Name:ROSE
Last Name:FARIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DELAINE
Other - Middle Name:ROSE
Other - Last Name:FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6721 EARNHART
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4171
Mailing Address - Country:US
Mailing Address - Phone:361-510-6796
Mailing Address - Fax:
Practice Address - Street 1:7426 S STAPLES ST STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5382
Practice Address - Country:US
Practice Address - Phone:361-452-7267
Practice Address - Fax:361-992-6427
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist