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General NPI Number Information
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NPI Number | 1356493902
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Entity Type | Organization
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Legal Business Name | MCEWEN DENTAL ASSOCIATES
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161 RAILROAD ST SOUTH
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City | MCEWEN
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State | TN
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Zip | 37101
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Country | US
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Telephone | 931-582-6997
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Fax | 931-582-6989
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Provider Business Mailing Address
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Address Line | 161 RAILROAD ST SOUTH
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City | MCEWEN
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State | TN
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Zip | 37101
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Country | US
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Telephone | 931-582-6997
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Fax | 931-582-6989
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Authorized Official
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Title or Position | OFFICE ADMINISTRATION
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Name | MRS. BRIDGETT SPANGLER
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Credential | RDA
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Telephone | 931-582-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7681
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License Number State | TN
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