Provider Demographics
NPI:1215052972
Name:BIRCKHEAD, JAMES R (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:BIRCKHEAD
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 1:337 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3690
Mailing Address - Country:US
Mailing Address - Phone:615-452-1292
Mailing Address - Fax:615-451-9952
Practice Address - Street 1:337 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3690
Practice Address - Country:US
Practice Address - Phone:615-452-1292
Practice Address - Fax:615-451-9952
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice