Provider Demographics
NPI:1558372250
Name:WHITEHEAD, BEN EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:EDWARD
Last Name:WHITEHEAD
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 1:2381 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:MCKENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-2214
Mailing Address - Country:US
Mailing Address - Phone:731-352-3363
Mailing Address - Fax:731-352-3604
Practice Address - Street 1:2381 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2214
Practice Address - Country:US
Practice Address - Phone:731-352-3363
Practice Address - Fax:731-352-3604
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 2614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist