1043603996 NPI number — DENTAL SPECIALTY EDUCATION, INC

Table of content: (NPI 1043603996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043603996 NPI number — DENTAL SPECIALTY EDUCATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SPECIALTY EDUCATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENTAL SPECIALTY EDUCATION, INC. - NASHVILLE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043603996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 MURFREESBORO PIKE
Provider Second Line Business Mailing Address:
BUILDING 1
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37210-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-256-7543
Provider Business Mailing Address Fax Number:
615-256-8895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 MURFREESBORO PIKE
Provider Second Line Business Practice Location Address:
BUILDING 1
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37210-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-256-7543
Provider Business Practice Location Address Fax Number:
615-256-8895
Provider Enumeration Date:
03/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
EWING
Authorized Official First Name:
SABIN
Authorized Official Middle Name:
KANE
Authorized Official Title or Position:
CLINICAL DENTAL DIRECTOR OF SCHOOL
Authorized Official Telephone Number:
615-256-7543

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0106X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043603996 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q012250 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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