Provider Demographics
NPI:1639143704
Name:DEARINGER, MICHELLE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:DEARINGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:708 W MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9682
Mailing Address - Country:US
Mailing Address - Phone:417-494-5017
Mailing Address - Fax:417-494-5019
Practice Address - Street 1:723 W MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9663
Practice Address - Country:US
Practice Address - Phone:417-725-3665
Practice Address - Fax:417-724-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0161301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1100329OtherSTATE DRUG LICENSE