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NPI Code Detail

MEDICARE: DR. BRANDON CHRISTIAN BIRDWELL DDS

MEDICARE: DR. BRANDON CHRISTIAN BIRDWELL DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry8306TN

General Provider Information

NPI Number : 1053497024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON CHRISTIAN BIRDWELL DDS
Provider Business Mailing Address
First Line : 990 ELLISTON WAY 103
Second Line :
City : THOMPSONS STATION
State : TN
Zip : 37179-5482
Country : US
Telephone Number : 615-550-4620
Fax Number : 615-550-4626
Provider Business Practice Location Address
First Line : 5226 MAIN ST
Second Line : SUITE 6
City : SPRING HILL
State : TN
Zip : 37174-7410
Country : US
Telephone Number : 615-302-0141
Fax Number : 615-302-1841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 12/29/2015

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