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General NPI Number Information
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NPI Number | 1144312851
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Entity Type | Organization
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Legal Business Name | S AND S DENTAL
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 E OLTORF ST SUITE #103
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City | AUSTIN
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State | TX
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Zip | 78741-4500
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Country | US
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Telephone | 512-326-3003
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Fax | 512-326-5304
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Provider Business Mailing Address
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Address Line | 2121 E OLTORF ST SUITE #103
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City | AUSTIN
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State | TX
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Zip | 78741-4500
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Country | US
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Telephone | 512-326-3003
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Fax | 512-326-5304
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MR. MICHAEL SHAYNE ISTRE
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Credential | DDS
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Telephone | 512-426-2619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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