NPI 1104193366

Charles H. Shanks, D.D.S., P.C.

Organisation Preferred Provider Organization Maryville, TN

Practice location

Address: 1511 E Lamar Alexander Pkwy, Maryville, TN 37804-5131
Phone: (865) 977-8048
Fax: (865) 977-0318

Authorised official

Name: Charles Hartwell Shanks
Title: Owner
Phone: (865) 977-8048

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence DS7825 (TN)

Other Preferred Provider Organization providers in Tennessee →

Registry record

NPI: 1104193366
Entity type: Organization
NPI issued: 16 Nov 2011
Record last updated: 10 Feb 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.