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NPI Code Detail

MEDICARE: SS MCNABB DENTAL, P.A.

MEDICARE: SS MCNABB DENTAL, P.A.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1265750558
Entity Type Code : Organization
Provider Name (Legal Business Name) : SS MCNABB DENTAL, P.A.
Provider Business Mailing Address
First Line : 941 E PARK ROW DR
Second Line : A
City : ARLINGTON
State : TX
Zip : 76010-4508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8522 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-5543
Country : US
Telephone Number : 512-832-6225
Fax Number : 512-832-8454
Authorized Official
Title or Position : OWNER
Name : MICHAEL SHAYNE ISTRE
Credential : DDS
Telephone Number : 512-832-6225
Provider Enumeration Date : 05/11/2010
Last Update Date : 05/11/2010

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