Provider Demographics
NPI:1134324478
Name:HEDGECOCK, MICHELLE RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:HEDGECOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:HEDGECOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:101 JUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870
Mailing Address - Country:US
Mailing Address - Phone:417-673-4073
Mailing Address - Fax:
Practice Address - Street 1:1008 MOPAC CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7874
Practice Address - Country:US
Practice Address - Phone:512-501-2385
Practice Address - Fax:512-233-2636
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070154711223G0001X
TX263521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice