| NPI | 1619128865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABIN K EWING Pediatric Dentist 931-645-8575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 9738) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 8588) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: TN 7907) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN 9072) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2017-03-09 |