Provider Demographics
NPI:1740369545
Name:BIRDWELL, BENJAMIN REUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:REUEL
Last Name:BIRDWELL
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 1:6714 SPRINGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6731
Mailing Address - Country:US
Mailing Address - Phone:865-577-5468
Mailing Address - Fax:423-318-8376
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4632
Practice Address - Country:US
Practice Address - Phone:423-318-8399
Practice Address - Fax:423-318-8376
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS23081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health