# CARROLL R. SHANKS, D.D.S., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CARROLL R. SHANKS, D.D.S., P.C.
- **Other names:** Carroll R. Shanks, D.D.S., P.C.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144507351
- **Legal business name:** CARROLL R. SHANKS, D.D.S., P.C.
- **Authorized official:** CARROLL RUDOLPH SHANKS ORAL SURGEON (OWNER)
- **Authorized official phone:** (865) 977-8048

## Contact information

- **Practice address:** 1511 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
- **Practice address phone:** (865) 977-8048
- **Practice address fax:** (865) 977-0318
- **Mailing address:** 1511 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
- **Mailing address phone:** (865) 977-8048
- **Mailing address fax:** (865) 977-0318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | TN2381 | TN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | TN2381 | TN | Yes |

## Other

- **Enumeration date:** 11/16/2011
- **Last updated:** 08/29/2012