Provider Demographics
NPI:1063535383
Name:BIRDWELL, CHRIS R (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:R
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 1:529 E GOVERNOR JOHN SEVIER HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6711
Mailing Address - Country:US
Mailing Address - Phone:865-573-9629
Mailing Address - Fax:
Practice Address - Street 1:529 E GOVERNOR JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6711
Practice Address - Country:US
Practice Address - Phone:865-573-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 73671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice