Provider Demographics
NPI:1144863861
Name:MICHELLE HEDGECOCK DDS PLLC
Entity type:Organization
Organization Name:MICHELLE HEDGECOCK DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEDGECOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-501-2385
Mailing Address - Street 1:1008 MOPAC CIRCLE
Mailing Address - Street 2:STE. 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-501-2385
Mailing Address - Fax:
Practice Address - Street 1:1008 MO PAC CIRCLE STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6808
Practice Address - Country:US
Practice Address - Phone:512-501-2385
Practice Address - Fax:512-233-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty