Individual
JOHN VAN BRADLEY SHANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3086 MAIN STREET, PIKEVILLE, TN 37367
(423) 447-2421
(423) 447-3408
Mailing address
3086 MAIN STREET, PIKEVILLE, TN 37367
(423) 447-2421
(423) 447-3408
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9128
TN
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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