Provider Demographics
NPI:1336218809
Name:WEST, MICHELLE RENEE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:WEST
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 1:101 JONATHAN DR
Mailing Address - Street 2:# 1
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6357
Mailing Address - Country:US
Mailing Address - Phone:512-778-9977
Mailing Address - Fax:512-778-9988
Practice Address - Street 1:101 JONATHAN DR
Practice Address - Street 2:# 1
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6357
Practice Address - Country:US
Practice Address - Phone:512-778-9977
Practice Address - Fax:512-778-9988
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice