MEDICARE: DR. MICHELLE RENEE HEDGECOCK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2007015471	MO
2	1223G0001X	General Practice Dentistry	26352	TX

General Provider Information

NPI Number	:	1134324478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE RENEE HEDGECOCK D.D.S.

Provider Business Mailing Address
First Line	:	101 JUSTIN BLVD
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870
Country	:	US
Telephone Number	:	417-673-4073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 MOPAC CIRCLE
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78746-7874
Country	:	US
Telephone Number	:	512-501-2385
Fax Number	:	512-233-2636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	02/12/2021

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