| NPI | 1114272580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HARTWELL SHANKS Owner/Oral Surgeon 865-977-8048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS7825) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS7825) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2013-06-17 |