Provider Demographics
NPI:1376274472
Name:COSME, MICHELLE STEPHANIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:STEPHANIE
Last Name:COSME
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 1:4424 CASTOR ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3504
Mailing Address - Country:US
Mailing Address - Phone:832-618-8293
Mailing Address - Fax:
Practice Address - Street 1:1906 S COLORADO ST STE 110
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3906
Practice Address - Country:US
Practice Address - Phone:512-213-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist