Provider Demographics
NPI:1578896973
Name:S & N DENTAL
Entity Type:Organization
Organization Name:S & N DENTAL
Other - Org Name:CARNAVAL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-454-4646
Mailing Address - Street 1:8716 RESEARCH BLVD
Mailing Address - Street 2:# 125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6420
Mailing Address - Country:US
Mailing Address - Phone:512-454-4646
Mailing Address - Fax:512-419-0561
Practice Address - Street 1:8716 RESEARCH BLVD
Practice Address - Street 2:# 125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6420
Practice Address - Country:US
Practice Address - Phone:512-454-4646
Practice Address - Fax:512-419-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty