Provider Demographics
NPI:1821161969
Name:SFDG, LLC
Entity Type:Organization
Organization Name:SFDG, LLC
Other - Org Name:SHALLOWFORD FAMILY DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-892-4477
Mailing Address - Street 1:6101 SHALLOWFORD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7802
Mailing Address - Country:US
Mailing Address - Phone:423-892-4477
Mailing Address - Fax:423-892-4229
Practice Address - Street 1:6101 SHALLOWFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7802
Practice Address - Country:US
Practice Address - Phone:423-892-4477
Practice Address - Fax:423-892-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN79701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty