Provider Demographics
NPI:1821188673
Name:EBEYER, MICHELLE TISSOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:TISSOT
Last Name:EBEYER
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 1:973 EMERSON PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6906
Mailing Address - Country:US
Mailing Address - Phone:317-883-3368
Mailing Address - Fax:317-883-3120
Practice Address - Street 1:973 EMERSON PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6906
Practice Address - Country:US
Practice Address - Phone:317-883-3368
Practice Address - Fax:317-883-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010147A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice