Provider Demographics
NPI:1356660260
Name:SS POWERS DENTAL, P.A.
Entity Type:Organization
Organization Name:SS POWERS DENTAL, P.A.
Other - Org Name:THE SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-832-6225
Mailing Address - Street 1:4825 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-1811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4825 CONCORD RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-1811
Practice Address - Country:US
Practice Address - Phone:512-832-6225
Practice Address - Fax:512-832-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty