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Organization
SHANK CENTER FOR DENTISTRY LLC
Active
Organization
SHANK CENTER FOR DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE WESLEY SHANK D.D.S. (SOLE MEMBER)
(317) 788-4239
Entity
Organization
Contact information
Practice address
6904 S EAST ST, SUITE F, INDIANAPOLIS, IN 46227-2693
(317) 788-4239
Mailing address
6904 S EAST ST, SUITE F, INDIANAPOLIS, IN 46227-2693
(317) 788-4239
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1201391A
IN
1223G0001X
General Practice Dentistry
1201391A
IN
Other
Enumeration date
01/18/2011
Last updated
01/30/2017
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