| Smile Center Pa | |
|
1144 Airport Blvd #240 Austin TX 78702 | |
| (512) 929-7888 | |
| (512) 929-8091 |
| Full Name | Smile Center Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1144 Airport Blvd, Austin, Texas |
| Authorized Official Name and Position | Michael Shayne Istre (OWNER PRESIDENT) |
| Authorized Official Contact | 5125358911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Center Pa 1144 Airport Blvd #240 Austin TX 78702 Ph: (512) 929-7888 | Smile Center Pa 1144 Airport Blvd #240 Austin TX 78702 Ph: (512) 929-7888 |
| NPI Number | 1144312836 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 08/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144312836 | NPI | - | NPPES |
| 091333701 | Medicaid | TX | |
| G60109-3 | Other | TX | TEXAS CHIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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