Provider Demographics
NPI:1295225639
Name:FERREIRA DE SOUZA, MICHELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:FERREIRA DE SOUZA
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 1:4707 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-5875
Mailing Address - Country:US
Mailing Address - Phone:512-815-7189
Mailing Address - Fax:
Practice Address - Street 1:13048 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3205
Practice Address - Country:US
Practice Address - Phone:512-257-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice