Provider Demographics
NPI:1740646439
Name:DENTAL SPECIALTY EDUCATION, INC.
Entity type:Organization
Organization Name:DENTAL SPECIALTY EDUCATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DENTAL DIRECTOR OF SCHOOL
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 A
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7170
Mailing Address - Country:US
Mailing Address - Phone:615-247-7100
Mailing Address - Fax:615-247-7052
Practice Address - Street 1:6509 HIGHWAY 41A
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7170
Practice Address - Country:US
Practice Address - Phone:615-247-7100
Practice Address - Fax:615-247-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012250Medicaid
TNDDS 7907OtherDENTAL LICENSE