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Organization
SOUTHPARK SMILES,PC
Active
Organization
SOUTHPARK SMILES,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKSON ROBERT BOOTH D.D.S. (DENTIST)
(512) 739-9440
Entity
Organization
Contact information
Practice address
9500 S INTERSTATE 35, SUITE E-400, AUSTIN, TX 78748-1752
(512) 282-7200
Mailing address
1603 NASH AVE, AUSTIN, TX 78704-3331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/06/2008
Last updated
10/06/2008
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