# SHANK ORTHODONTICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972891687
- **Authorized official:** DR. STEPHANIE BROOKE SHANK D.D.S, M.S. (SOLE MEMBER)
- **Authorized official phone:** (317) 888-9833

## Contact information

- **Practice address:** 1700 W SMITH VALLEY RD, SUITE A-1, GREENWOOD, IN 46142-1599
- **Practice address phone:** (317) 888-9833
- **Practice address fax:** (317) 885-1754
- **Mailing address:** 1700 W SMITH VALLEY RD, SUITE A-1, GREENWOOD, IN 46142-1599
- **Mailing address phone:** (317) 888-9833
- **Mailing address fax:** (317) 885-1754

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12011699A | IN | Yes |

## Other

- **Enumeration date:** 07/14/2011
- **Last updated:** 11/04/2016