Provider Demographics
NPI:1447342159
Name:S & P DENTAL
Entity type:Organization
Organization Name:S & P DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHAYNE
Authorized Official - Last Name:ISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-426-2619
Mailing Address - Street 1:8522 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5543
Mailing Address - Country:US
Mailing Address - Phone:512-832-8448
Mailing Address - Fax:512-832-8454
Practice Address - Street 1:8522 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5543
Practice Address - Country:US
Practice Address - Phone:512-832-8448
Practice Address - Fax:512-832-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60109-2OtherTEXAS CHIP PROVIDER NUMBE