Provider Demographics
NPI:1639593072
Name:AFFORDABLE DENTAL TULLAHOMA
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL TULLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCALLIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-454-0001
Mailing Address - Street 1:1958 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2204
Mailing Address - Country:US
Mailing Address - Phone:931-454-0001
Mailing Address - Fax:931-454-0973
Practice Address - Street 1:1958 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2204
Practice Address - Country:US
Practice Address - Phone:931-454-0001
Practice Address - Fax:931-454-0973
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE DENTAL AND DENTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty