Provider Demographics
NPI:1518031616
Name:JAMISON, BENJAMIN KING (D D S)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KING
Last Name:JAMISON
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2642
Mailing Address - Country:US
Mailing Address - Phone:615-893-6123
Mailing Address - Fax:615-895-5171
Practice Address - Street 1:1211 LEAF AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2642
Practice Address - Country:US
Practice Address - Phone:615-893-6123
Practice Address - Fax:615-895-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS37631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice