Provider Demographics
NPI:1700156429
Name:HOUTS, MICHELLE LEE (RDH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:HOUTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 417 BOX 5146
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09075-0002
Mailing Address - Country:US
Mailing Address - Phone:01514-451-1941
Mailing Address - Fax:
Practice Address - Street 1:BLDG. # 5810 KATTERBACH ST
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09250
Practice Address - Country:US
Practice Address - Phone:314-467-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006218124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist