Benjamin James Perrault, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

12638 Issued in TN

Practice address

1203 N Wilcox Dr
Kingsport, TN 37660-4971

Phone

(423) 247-5175

NPI assigned

Aug 25, 2022

Last updated

Jan 31, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DRS Carver Stakias Mather & Smith PC

  • Dentist
  • Kingsport, TN
  • NPI 1740322262
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1821717448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 N WILCOX DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 N WILCOX DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604971",
            "telephone_number": "423-247-5175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRAULT",
        "first_name": "BENJAMIN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-25",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12638",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00205337",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Pendleton, FNP
• Christopher A Pendola, M.D.
• Skylar Dane Pentasuglia, AUD
• Katie E Perdue
• Kiley Morgan Perethian, D.O.
• Jennifer Carlita Peters-Diamond, MD
• Mary Louise Peters
• Shae Peters
• Heather Phelps, NP-C
• Phillip Marshall DDS PC

• Dentist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.