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Organization
S & P DENTAL
Active
Organization
S & P DENTAL
Active
Other names
THE SMILE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SHAYNE ISTRE DDS (DIRECT OWNER)
(512) 426-2619
Entity
Organization
Contact information
Practice address
8522 N LAMAR BLVD, AUSTIN, TX 78753-5543
(512) 832-8448
(512) 832-8454
Mailing address
8522 N LAMAR BLVD, AUSTIN, TX 78753-5543
(512) 832-8448
(512) 832-8454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G60109-2
TEXAS CHIP PROVIDER NUMBE
TX
Enumeration date
09/29/2006
Last updated
08/22/2020
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