Provider Demographics
NPI:1538306329
Name:MCEWEN DENTAL SPECIALITIES
Entity type:Organization
Organization Name:MCEWEN DENTAL SPECIALITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:N
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:931-582-6997
Mailing Address - Street 1:161 RAILROAD STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:MCEWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101
Mailing Address - Country:US
Mailing Address - Phone:931-582-6997
Mailing Address - Fax:931-582-6989
Practice Address - Street 1:161 RAILROAD ST S
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4762
Practice Address - Country:US
Practice Address - Phone:931-582-6997
Practice Address - Fax:931-582-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76811223S0112X
TN47471223X0400X
TN68651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty