Provider Demographics
NPI:1144361882
Name:BIRDWELL, BEN JASON JR (DDS)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:JASON
Last Name:BIRDWELL
Suffix:JR
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 1:300 SEABOARD LN
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2821
Mailing Address - Country:US
Mailing Address - Phone:615-771-3180
Mailing Address - Fax:615-771-0144
Practice Address - Street 1:300 SEABOARD LN
Practice Address - Street 2:SUITE 7
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2821
Practice Address - Country:US
Practice Address - Phone:615-771-3180
Practice Address - Fax:615-771-0144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice