Healthcare Provider Details

I. General information

NPI: 1043603996
Provider Name (Legal Business Name): DENTAL SPECIALTY EDUCATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 MURFREESBORO PIKE BUILDING 1
NASHVILLE TN
37210-2842
US

IV. Provider business mailing address

451 MURFREESBORO PIKE BUILDING 1
NASHVILLE TN
37210-2842
US

V. Phone/Fax

Practice location:
  • Phone: 615-256-7543
  • Fax: 615-256-8895
Mailing address:
  • Phone: 615-256-7543
  • Fax: 615-256-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. SABIN KANE EWING
Title or Position: CLINICAL DENTAL DIRECTOR OF SCHOOL
Credential: DDS
Phone: 615-256-7543