Provider Demographics
NPI:1013000827
Name:KLEINHEIDER, MICHELLE PARRA
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PARRA
Last Name:KLEINHEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 COLONNADE CTR
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4328
Mailing Address - Country:US
Mailing Address - Phone:314-822-0018
Mailing Address - Fax:314-822-3802
Practice Address - Street 1:1167 COLONNADE CTR
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4328
Practice Address - Country:US
Practice Address - Phone:314-822-0018
Practice Address - Fax:314-822-3802
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0159721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice