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NPI Code Detail

MEDICARE: S & P DENTAL

MEDICARE: S & P 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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G60109-2OTHERTXTEXAS CHIP PROVIDER NUMBE

General Provider Information

NPI Number : 1447342159
Entity Type Code : Organization
Provider Name (Legal Business Name) : S & P DENTAL
Provider Business Mailing Address
First Line : 8522 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-5543
Country : US
Telephone Number : 512-832-8448
Fax Number : 512-832-8454
Provider Business Practice Location Address
First Line : 8522 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-5543
Country : US
Telephone Number : 512-832-8448
Fax Number : 512-832-8454
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 & P DENTAL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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