| NPI | 1144507351 |
|---|---|
| Doing Business As | CARROLL R. SHANKS, D.D.S., P.C. |
| Entity Type | Organization |
| Authorized Contact | CARROLL RUDOLPH SHANKS Owner 865-977-8048 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN TN2381) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN TN2381) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2012-08-29 |