Provider Demographics
NPI:1174393896
Name:SANGO HILLS DENTAL PLLC
Entity type:Organization
Organization Name:SANGO HILLS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BURKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-980-1562
Mailing Address - Street 1:590 FIRE STATION RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4076
Mailing Address - Country:US
Mailing Address - Phone:931-820-2693
Mailing Address - Fax:931-378-6076
Practice Address - Street 1:590 FIRE STATION RD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4076
Practice Address - Country:US
Practice Address - Phone:931-820-2693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental