Healthcare Provider Details

I. General information

NPI: 1689957169
Provider Name (Legal Business Name): SANOVA DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 N MOPAC EXPY STE 100
AUSTIN TX
78758-2486
US

IV. Provider business mailing address

PO BOX 746768
ATLANTA GA
30374-6768
US

V. Phone/Fax

Practice location:
  • Phone: 512-837-3376
  • Fax: 512-837-3377
Mailing address:
  • Phone: 512-837-3376
  • Fax: 512-837-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD LAIN
Title or Position: PRESIDENT/MD
Credential: MD
Phone: 512-266-0007