Provider Demographics
NPI:1205035219
Name:KIZER, BENNETT MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:MARTIN
Last Name:KIZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 WALDEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6355
Mailing Address - Country:US
Mailing Address - Phone:865-588-1294
Mailing Address - Fax:865-588-6678
Practice Address - Street 1:6001 WALDEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6355
Practice Address - Country:US
Practice Address - Phone:865-588-1294
Practice Address - Fax:865-588-6678
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist