Provider Demographics
NPI:1154432821
Name:WESTLAKE ENDODONTICS PA
Entity type:Organization
Organization Name:WESTLAKE ENDODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHOU
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-330-9016
Mailing Address - Street 1:4201 BEE CAVES RD
Mailing Address - Street 2:SUITE C-104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-330-9016
Mailing Address - Fax:512-330-9962
Practice Address - Street 1:4201 BEE CAVES RD
Practice Address - Street 2:SUITE C-104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-330-9016
Practice Address - Fax:512-330-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty