Provider Demographics
NPI:1588785588
Name:VONBIEBERSTEIN, MICHELLE MCCLINTOCK (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MCCLINTOCK
Last Name:VONBIEBERSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MCCLINTOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:14626 FM 2100 RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-9133
Mailing Address - Country:US
Mailing Address - Phone:281-328-3525
Mailing Address - Fax:
Practice Address - Street 1:14626 FM 2100 RD
Practice Address - Street 2:SUITE A
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9133
Practice Address - Country:US
Practice Address - Phone:281-328-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0160101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice