Provider Demographics
NPI:1598830770
Name:BENNERMAN, CHRISTIAN CLARENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:CLARENCE
Last Name:BENNERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13181 OLD NASHVILLE HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4032
Mailing Address - Country:US
Mailing Address - Phone:615-459-9296
Mailing Address - Fax:615-459-9686
Practice Address - Street 1:2653 LAKEVILLA DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3836
Practice Address - Country:US
Practice Address - Phone:615-840-8149
Practice Address - Fax:615-982-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ052725Medicaid