Provider Demographics
NPI:1578666475
Name:FREEZE, MICHELLE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:FREEZE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4308 N. QUINLAN PARK RD
Mailing Address - Street 2:201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732
Mailing Address - Country:US
Mailing Address - Phone:512-266-7200
Mailing Address - Fax:512-266-6197
Practice Address - Street 1:4308 N. QUINLAN PARK RD
Practice Address - Street 2:STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732
Practice Address - Country:US
Practice Address - Phone:512-266-7200
Practice Address - Fax:512-266-6197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX216351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry