Organization
SHANE ISTRE DENTAL ASSOCIATES
Active
Organization
SHANE ISTRE DENTAL ASSOCIATES
Active
Other names
SMILE CENTER PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SHAYNE ISTRE DDS (OWNER PRESIDENT)
(512) 535-8911
Entity
Organization
Contact information
Practice address
1144 AIRPORT BLVD, #240, AUSTIN, TX 78702
(512) 929-7888
(512) 929-8091
Mailing address
1144 AIRPORT BLVD, #240, AUSTIN, TX 78702
(512) 929-7888
(512) 929-8091
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091333701
—
TX
01
—
G60109-3
TEXAS CHIP
TX
Enumeration date
09/29/2006
Last updated
08/28/2008
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