Provider Demographics
NPI:1003272790
Name:CHILDREN'S DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH CENTER
Other - Org Name:CHILDREN'S DENTAL HEALTH CENTER - NASHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABIN
Authorized Official - Middle Name:KANE
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-256-7543
Mailing Address - Street 1:451 MURFREESBORO PIKE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2842
Mailing Address - Country:US
Mailing Address - Phone:615-256-7543
Mailing Address - Fax:615-256-8895
Practice Address - Street 1:451 MURFREESBORO PIKE
Practice Address - Street 2:BUILDING 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2842
Practice Address - Country:US
Practice Address - Phone:615-256-7543
Practice Address - Fax:615-256-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79071223G0001X, 1223X0400X
TN90721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7907OtherDENTAL LICENSE