Provider Demographics
NPI:1639218555
Name:WHITE, MICHELE SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:SUSAN
Last Name:WHITE
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 1:7338 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3633
Mailing Address - Country:US
Mailing Address - Phone:713-649-3020
Mailing Address - Fax:713-649-3020
Practice Address - Street 1:7338 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3633
Practice Address - Country:US
Practice Address - Phone:713-649-3020
Practice Address - Fax:713-649-3020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117867OtherDENTAL BENEFIT PROVIDER
TX19158OtherLICENSE #
TXB1915801OtherTEXAS CHIP
TXD284806OtherCIGNA INS.
TX553022OtherUNITED CONCORDIA