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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