Healthcare Provider Details

I. General information

NPI: 1154432821
Provider Name (Legal Business Name): WESTLAKE ENDODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BEE CAVES RD SUITE C-104
AUSTIN TX
78746
US

IV. Provider business mailing address

4201 BEE CAVES RD SUITE C-104
AUSTIN TX
78746
US

V. Phone/Fax

Practice location:
  • Phone: 512-330-9016
  • Fax: 512-330-9962
Mailing address:
  • Phone: 512-330-9016
  • Fax: 512-330-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHOU TRAN SHELL
Title or Position: ENDODONTIST PRESIDENT
Credential: DDS
Phone: 512-330-9016