Provider Demographics
NPI:1699168062
Name:EWING ORTHODONTIC INC.
Entity type:Organization
Organization Name:EWING ORTHODONTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ORTHODONTICS
Authorized Official - Prefix:
Authorized Official - First Name:SABIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-256-7543
Mailing Address - Street 1:451 MURFREESBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2842
Mailing Address - Country:US
Mailing Address - Phone:615-256-7543
Mailing Address - Fax:615-256-8895
Practice Address - Street 1:739 PRESIDENT PL
Practice Address - Street 2:SUITE 210
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6844
Practice Address - Country:US
Practice Address - Phone:615-220-8585
Practice Address - Fax:615-220-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440034Medicaid
TNQ011964Medicaid