Individual
CHARLES HARTWELL SHANKS
Active
Individual
CHARLES HARTWELL SHANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
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
—
1144507351
GROUP NPI
TN
01
—
1223S0112X
KENTUCKY MEDICAID TAXONOMY CODE
TN
01
—
201169265
TAX ID
TN
01
—
DS7825
LICENSE #
TN
Enumeration date
10/12/2005
Last updated
06/17/2013
Update your record
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