Provider Demographics
NPI:1043323603
Name:BOOTH, STEVEN LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LESLIE
Last Name:BOOTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 JOLLYVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2350
Mailing Address - Country:US
Mailing Address - Phone:512-345-8800
Mailing Address - Fax:512-331-8500
Practice Address - Street 1:11851 JOLLYVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2350
Practice Address - Country:US
Practice Address - Phone:512-345-8800
Practice Address - Fax:512-331-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice