JOHN JACOB SHANK (NPI# 1154349439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154349439 |
| Entity Type | Individual |
| Full Name | JOHN JACOB SHANK |
| Credential | DDS |
| Practice Address |
2121 E Dupont Rd Ste C Fort Wayne IN 46825-1546 |
| Practice Telephone | 2604902013 |
| Practice Fax Number | 2604901081 |
| Mailing Telephone | 2604902013 |
| Mailing Fax Number | 2604901081 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2009-01-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12009584 | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD | 000000214282 | 01 | |
| IN | 200169990A | 05 | |
| RAILROAD MEDICARE | 190009098 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073747200 | John W. Shank | Recreation Therapist | 1413 Hillside Rd, Wynnewood, PA 19096-2406 | 2009-05-01 |
| 1730576158 | John Paul Shank | Nurse Practitioner | 228 Saint Charles Way Ste 300, York, PA 17402-4661 | 2015-04-23 |
| 1538296215 | John Shank | Optometrist | 3450 E. Rezanof Dr., Kodiak, AK 99615 | 2007-02-28 |
| 1831141290 | John R Shank | Orthopaedic Surgery | 2446 Research Pkwy, Suite 200, Colorado Springs, CO 80920-1087 | 2006-05-16 |
| 1306835152 | John Stephen Shank | Family Medicine | 350 Fairview Heights Rd, Summersville, WV 26651 | 2005-10-14 |
| Street Address |
2121 E DUPONT RD STE C |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46825-1546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
| 1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
| 1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
| 1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
| 1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
| 1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
| Find all providers in zip 46825 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093250151 | Ruckman Oral Surgery and Implant Center LLC | Dentist | 9901 Auburn Rd, Fort Wayne, IN 46825-2345 | 2016-12-28 |
| 1942399159 | Ryan M. Diepenbrock | Dentist | 7845 Carnegie Blvd Ste A, Fort Wayne, IN 46804-5792 | 2006-10-12 |
| 1245240399 | Michael J Stronczek | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2006-08-09 |
| 1487664512 | David G Bojrab | Dentist | 4606 D East State Blvd, Fort Wayne, IN 46815 | 2006-08-09 |
| 1598781106 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2006-07-15 |
| 1326421637 | James E. Dumas, Dds, PC | Dentist | 10020 Dupont Circle Ct., Suite 150, Fort Wayne, IN 46825-1635 | 2015-07-06 |
| 1982830766 | Yash Kumar Singh | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2009-06-07 |
| 1033366711 | Lucas S Reed | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2008-08-25 |
| 1376701045 | James Terrence O'neill | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804 | 2008-05-29 |
| 1558416883 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 7230 Engle Rd, Suite 301, Fort Wayne, IN 46804-2209 | 2007-01-25 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46825 |
Please comment or provide details below to improve the information on JOHN JACOB SHANK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.