Provider Demographics
NPI:1982000873
Name:CERTUCHE, FARIDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIDE
Middle Name:
Last Name:CERTUCHE
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 1:4142 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1008
Mailing Address - Country:US
Mailing Address - Phone:713-661-4234
Mailing Address - Fax:713-661-7625
Practice Address - Street 1:4142 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1008
Practice Address - Country:US
Practice Address - Phone:713-661-4234
Practice Address - Fax:713-661-7625
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist