Provider Demographics
NPI:1346207859
Name:LA BEAU, MICHELLE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:LA BEAU
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 1:7550 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4761
Mailing Address - Country:US
Mailing Address - Phone:952-703-9957
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S
Practice Address - Street 2:SUITE 138
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5624
Practice Address - Country:US
Practice Address - Phone:952-703-9957
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist