Organization
CHARLES H. SHANKS, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES HARTWELL SHANKS D.D.S. (OWNER/ORAL SURGEON)
(865) 977-8048
Entity
Organization
Contact information
Practice address
1511 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 977-8048
(865) 977-0318
Mailing address
1511 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 977-8048
(865) 977-0318
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS7825
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS7825
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114272580
GROUP NPI
TN
01
—
1223S0112X
ORAL SURGERY TAXONOMY NUMBER
TN
Enumeration date
07/20/2012
Last updated
06/17/2013
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