Provider Demographics
NPI:1619128865
Name:AFFORDABLE DENTAL INCORPORATED
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SABIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-645-8575
Mailing Address - Street 1:1833 MEMORIAL DR.
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-645-8575
Mailing Address - Fax:931-645-8120
Practice Address - Street 1:1833 MEMORIAL DR.
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-645-8575
Practice Address - Fax:931-645-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN97381223G0001X
TN85881223G0001X
TN79071223P0221X
TN90721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1841292737OtherINDIVIDUAL NPI
TNQ001138Medicaid
TN1497084057OtherINDIVIDUAL NPI
TN5440034Medicaid
TN1083749055OtherINDIVIDUAL NPI
TN1517610Medicaid
TN1275895724OtherINDIVIDUAL NPI