| Southpark Smiles,pc | |
|
9500 S Interstate 35 Suite E-400 Austin TX 78748-1752 | |
| (512) 282-7200 | |
| Not Available |
| Full Name | Southpark Smiles,pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9500 S Interstate 35, Austin, Texas |
| Authorized Official Name and Position | Jackson Robert Booth (DENTIST) |
| Authorized Official Contact | 5127399440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southpark Smiles,pc 1603 Nash Ave Austin TX 78704-3331 Ph: () - | Southpark Smiles,pc 9500 S Interstate 35 Suite E-400 Austin TX 78748-1752 Ph: (512) 282-7200 |
| NPI Number | 1922259266 |
|---|---|
| Provider Enumeration Date | 10/06/2008 |
| Last Update Date | 10/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922259266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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