Provider Demographics
NPI:1144312851
Name:S AND S DENTAL
Entity type:Organization
Organization Name:S AND S 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 1:2121 E OLTORF ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-4500
Mailing Address - Country:US
Mailing Address - Phone:512-326-3003
Mailing Address - Fax:512-326-5304
Practice Address - Street 1:2121 E OLTORF ST
Practice Address - Street 2:SUITE #103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-4500
Practice Address - Country:US
Practice Address - Phone:512-326-3003
Practice Address - Fax:512-326-5304
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
TXG60901-1OtherTEXAS CHIP PROVIDER NUMBE