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General NPI Number Information
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NPI Number | 1184943086
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Entity Type | Organization
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Legal Business Name | SS POWERS DENTAL, P.A.
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 8522 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-5543
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Country | US
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Telephone | 512-832-6225
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Fax | 512-832-8454
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Provider Business Mailing Address
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Address Line | 4825 CONCORD RD
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City | BEAUMONT
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State | TX
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Zip | 77703-1811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SHAYNE ISTRE
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Credential | DDS
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Telephone | 512-832-6225
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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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