Provider Demographics
NPI:1588860126
Name:CONVERT, ANNE-LAURE CHARLOTTE (DDS)
Entity Type:Individual
Prefix:
First Name:ANNE-LAURE
Middle Name:CHARLOTTE
Last Name:CONVERT
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 1:15926 FLEETWOOD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1454 CAMPBELL RD
Practice Address - Street 2:STE200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4604
Practice Address - Country:US
Practice Address - Phone:713-722-8400
Practice Address - Fax:713-722-8441
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist