Provider Demographics
NPI:1043603996
Name:DENTAL SPECIALTY EDUCATION, INC
Entity Type:Organization
Organization Name:DENTAL SPECIALTY EDUCATION, INC
Other - Org Name:DENTAL SPECIALTY EDUCATION, INC. - NASHVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DENTAL DIRECTOR OF SCHOOL
Authorized Official - Prefix:DR
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:2015-03-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223G0001X, 1223P0106X, 1223P0221X, 1223X0400X, 1223G0001X, 1223P0106X, 1223P0221X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0008X, 1223X0400X, 122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty
No122400000XDental ProvidersDenturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1043603996OtherGROUP NPI
TNQ012250Medicaid