Southpark Smiles, PC

NPI #1215259684 in Austin, Texas

Provider Information

NPI Number: 1215259684
Entity Type: Organization
Organization Name: Southpark Smiles, PC
Primary Specialty: Dentist
Enumeration Date: Feb 25, 2010
Last Updated: Feb 25, 2010

Practice Location

Address: 4410 E RIVERSIDE DR
Address 2: SUITE 150
City: Austin
State: Texas
ZIP Code: 78741-4799
Phone: (512) 385-4700

Authorized Official

Name: DR. JACKSON R BOOTH, DDS
Title: PRESIDENT
Phone: (512) 282-7200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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