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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