Provider Demographics
NPI:1588030084
Name:CHILDREN'S DENTAL HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH CENTER, PLLC
Other - Org Name:CHILDREN'S DENTAL HEALTH CENTER - PLEASENT VIEW
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 1:6509 HIGHWAY 41A
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7170
Mailing Address - Country:US
Mailing Address - Phone:615-256-7543
Mailing Address - Fax:615-256-8895
Practice Address - Street 1:6509 HIGHWAY 41A
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7170
Practice Address - Country:US
Practice Address - Phone:615-256-7543
Practice Address - Fax:615-256-8895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S DENTAL HEALTH CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN97381223G0001X
TN99621223P0221X
TN90721223S0112X
TN91341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNNAOtherTHIS OFFICE DOES NOT ACCEPT MEDICAID