Provider Demographics
NPI:1295156016
Name:ISLA DENTAL
Entity type:Organization
Organization Name:ISLA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-831-5173
Mailing Address - Street 1:900 S WAYSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3427
Mailing Address - Country:US
Mailing Address - Phone:832-831-5173
Mailing Address - Fax:832-831-5174
Practice Address - Street 1:900 S WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3427
Practice Address - Country:US
Practice Address - Phone:832-831-5173
Practice Address - Fax:832-831-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty