Provider Demographics
NPI:1275674715
Name:HOUSH, MICHAEL LEE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:HOUSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E HOSPITAL ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744
Mailing Address - Country:US
Mailing Address - Phone:417-876-3124
Mailing Address - Fax:417-876-0054
Practice Address - Street 1:605 E HOSPITAL ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744
Practice Address - Country:US
Practice Address - Phone:417-876-3124
Practice Address - Fax:417-876-0054
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist