Healthcare Provider Details

I. General information

NPI: 1912025354
Provider Name (Legal Business Name): MICHELLE L. FREEZE, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 N. QUINLAN PARK RD STE 201
AUSTIN TX
78732
US

IV. Provider business mailing address

10900 LAKELINE MALL DR STE 250
AUSTIN TX
78717
US

V. Phone/Fax

Practice location:
  • Phone: 512-266-7200
  • Fax: 512-266-6197
Mailing address:
  • Phone: 512-266-7200
  • Fax: 512-583-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21635
License Number StateTX

VIII. Authorized Official

Name: DR. MICHELLE L FREEZE
Title or Position: OWNER, PEDIATRIC DENTIST
Credential: DMD
Phone: 512-266-7200