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General NPI Number Information
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NPI Number | 1831173392
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Entity Type | Organization
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Legal Business Name | J BENJAMIN RIVERS DMD PC
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 6906 KINGSTON PIKE SUITE 205
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City | KNOXVILLE
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State | TN
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Zip | 37919-5704
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Country | US
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Telephone | 865-588-3850
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Fax | 865-588-3840
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Provider Business Mailing Address
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Address Line | 6906 KINGSTON PIKE SUITE 205
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City | KNOXVILLE
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State | TN
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Zip | 37919-5704
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Country | US
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Telephone | 865-588-3850
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Fax | 865-588-3840
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES BENJAMIN RIVERS SR.
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Credential | DMD
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Telephone | 865-588-3850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 2075
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License Number State | TN
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