MEDICARE: SHANE ISTRE DENTAL ASSOCIATES

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
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G60109-3	OTHER	TX	TEXAS CHIP

General Provider Information

NPI Number	:	1144312836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANE ISTRE DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1144 AIRPORT BLVD
Second Line	:	#240
City	:	AUSTIN
State	:	TX
Zip	:	78702
Country	:	US
Telephone Number	:	512-929-7888
Fax Number	:	512-929-8091

Provider Business Practice Location Address
First Line	:	1144 AIRPORT BLVD
Second Line	:	#240
City	:	AUSTIN
State	:	TX
Zip	:	78702
Country	:	US
Telephone Number	:	512-929-7888
Fax Number	:	512-929-8091

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. MICHAEL SHAYNE ISTRE
Credential	:	DDS
Telephone Number	:	512-535-8911

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/28/2008

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Directions to “SHANE ISTRE DENTAL ASSOCIATES ” Practice Location

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