| Charles H. Shanks, D.d.s., P.c. | |
|
1511 E Lamar Alexander Pkwy Maryville TN 37804-5131 | |
| (865) 977-8048 | |
| (865) 977-0318 |
| Full Name | Charles H. Shanks, D.d.s., P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1511 E Lamar Alexander Pkwy, Maryville, Tennessee |
| Authorized Official Name and Position | Charles Hartwell Shanks (OWNER/ORAL SURGEON) |
| Authorized Official Contact | 8659778048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles H. Shanks, D.d.s., P.c. 1511 E Lamar Alexander Pkwy Maryville TN 37804-5131 Ph: (865) 977-8048 | Charles H. Shanks, D.d.s., P.c. 1511 E Lamar Alexander Pkwy Maryville TN 37804-5131 Ph: (865) 977-8048 |
| NPI Number | 1114272580 |
|---|---|
| Provider Enumeration Date | 07/20/2012 |
| Last Update Date | 06/17/2013 |
| Medicare PECOS PAC ID | 6305099516 |
|---|---|
| Medicare Enrollment ID | O20130118000296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114272580 | NPI | - | NPPES |
| 1114272580 | Other | TN | GROUP NPI |
| 1223S0112X | Other | TN | ORAL SURGERY TAXONOMY NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS7825 (Tennessee) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS7825 (Tennessee) | Primary |
| Provider Name | Charles H Shanks |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1558359695 PECOS PAC ID: 8224003439 Enrollment ID: I20040831001262 |
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