Provider Demographics
NPI:1912025354
Name:MICHELLE L. FREEZE, DMD, PLLC
Entity Type:Organization
Organization Name:MICHELLE L. FREEZE, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREEZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-266-7200
Mailing Address - Street 1:10900 LAKELINE MALL DR
Mailing Address - Street 2:STE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717
Mailing Address - Country:US
Mailing Address - Phone:512-266-7200
Mailing Address - Fax:512-583-0675
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1620639OtherUNITED CONCORDIA