Provider Demographics
NPI:1528189487
Name:BIVENS, CHARLES W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:BIVENS
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 1:1615 WOOD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4595
Mailing Address - Country:US
Mailing Address - Phone:423-745-1287
Mailing Address - Fax:
Practice Address - Street 1:800 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3430
Practice Address - Country:US
Practice Address - Phone:423-745-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice