Organization
CARROLL R. SHANKS, D.D.S., P.C.
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
Legal business name
CARROLL R. SHANKS, D.D.S., P.C.
Authorized official
CARROLL RUDOLPH SHANKS ORAL SURGEON (OWNER)
(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
TN2381
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
TN2381
TN
Other
Enumeration date
11/16/2011
Last updated
08/29/2012
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