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2121 E Oltorf St Suite #103 Austin TX 78741-4500 | |
| (512) 326-3003 | |
| (512) 326-5304 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2121 E Oltorf St, Austin, Texas |
| Authorized Official Name and Position | Michael Shayne Istre (DIRECT OWNER) |
| Authorized Official Contact | 5124262619 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2121 E Oltorf St Suite #103 Austin TX 78741-4500 Ph: (512) 326-3003 | 2121 E Oltorf St Suite #103 Austin TX 78741-4500 Ph: (512) 326-3003 |
| NPI Number | 1144312851 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144312851 | NPI | - | NPPES |
| G60901-1 | Other | TX | TEXAS CHIP PROVIDER NUMBE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Jared Poplin D.m.d., Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6850 Austin Center Blvd Ste 220, Austin, TX 78731 Phone: 785-691-6171 | |
Ac Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13616 N Highway 183, Austin, TX 78750 Phone: 512-682-5437 | |