Provider Demographics
NPI:1730278144
Name:BIRDWELL, GEORGE ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROBERT
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 1:253A LABORATORY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7004
Mailing Address - Country:US
Mailing Address - Phone:865-482-5170
Mailing Address - Fax:865-482-6092
Practice Address - Street 1:253A LABORATORY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7004
Practice Address - Country:US
Practice Address - Phone:865-482-5170
Practice Address - Fax:865-482-6092
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000023091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice