Provider Demographics
NPI:1639354582
Name:TESFAYE, GELATIA (DDS)
Entity type:Individual
Prefix:DR
First Name:GELATIA
Middle Name:
Last Name:TESFAYE
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 1:400 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4406
Mailing Address - Country:US
Mailing Address - Phone:281-342-5235
Mailing Address - Fax:
Practice Address - Street 1:10435 GREENBOUGH DR STE 300
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5034
Practice Address - Country:US
Practice Address - Phone:281-261-0182
Practice Address - Fax:281-969-1764
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist