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General NPI Number Information
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NPI Number | 1689957169
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Entity Type | Organization
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Legal Business Name | SANOVA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 12319 N MOPAC EXPY STE 100
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City | AUSTIN
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State | TX
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Zip | 78758-2486
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Country | US
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Telephone | 512-837-3376
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Fax | 512-837-3377
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Provider Business Mailing Address
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Address Line | PO BOX 746768
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City | ATLANTA
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State | GA
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Zip | 30374-6768
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Country | US
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Telephone | 512-837-3376
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Fax | 512-837-3377
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Authorized Official
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Title or Position | PRESIDENT/MD
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Name | DR. EDWARD LAIN
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Credential | MD
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Telephone | 512-266-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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