Provider Demographics
NPI:1881102747
Name:S & A GOLSHANI, PLLC
Entity type:Organization
Organization Name:S & A GOLSHANI, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GOLSHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-334-0345
Mailing Address - Street 1:5329 SERENE HILLS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1256
Mailing Address - Country:US
Mailing Address - Phone:512-334-0345
Mailing Address - Fax:
Practice Address - Street 1:5329 SERENE HILLS DR STE 104
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-1256
Practice Address - Country:US
Practice Address - Phone:512-334-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty