MEDICARE: S AND S DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G60901-1	OTHER	TX	TEXAS CHIP PROVIDER NUMBE

General Provider Information

NPI Number	:	1144312851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S AND S DENTAL

Provider Business Mailing Address
First Line	:	2121 E OLTORF ST
Second Line	:	SUITE #103
City	:	AUSTIN
State	:	TX
Zip	:	78741-4500
Country	:	US
Telephone Number	:	512-326-3003
Fax Number	:	512-326-5304

Provider Business Practice Location Address
First Line	:	2121 E OLTORF ST
Second Line	:	SUITE #103
City	:	AUSTIN
State	:	TX
Zip	:	78741-4500
Country	:	US
Telephone Number	:	512-326-3003
Fax Number	:	512-326-5304

Authorized Official
Title or Position	:	DIRECT OWNER
Name	:	MR. MICHAEL SHAYNE ISTRE
Credential	:	DDS
Telephone Number	:	512-426-2619

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/22/2020

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Directions to “S AND S DENTAL ” Practice Location

Language	Start Address	Practice Location

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