CHARLES HARTWELL SHANKS (NPI# 1558359695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558359695 |
| Entity Type | Individual |
| Full Name | CHARLES HARTWELL SHANKS |
| Credential | D.D.S. |
| Practice Address |
1511 E Lamar Alexander Pkwy Maryville TN 37804-5131 |
| Practice Telephone | 8659778048 |
| Practice Fax Number | 8659770318 |
| Mailing Telephone | 8659778048 |
| Mailing Fax Number | 8659770318 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2013-06-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | DS7825 | TN | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS7825 | TN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | GROUP NPI | 1144507351 | 01 |
| TN | TAX ID | 201169265 | 01 |
| TN | KENTUCKY MEDICAID TAXONOMY CODE | 1223S0112X | 01 |
| TN | LICENSE # | DS7825 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336273150 | Charles Dennis Shanks | Optometrist | 7110 Youree Drive, Shreveport, LA 71105 | 2007-03-15 |
| Street Address |
1511 E LAMAR ALEXANDER PKWY |
| City | MARYVILLE |
| State | TN |
| Zip Code | 37804-5131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114272580 | Charles H. Shanks, D.d.s., P.C. | Dentist | 1511 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2012-07-20 |
| 1144507351 | Carroll R. Shanks, D.d.s., P.C. | Dentist | 1511 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2011-11-16 |
| 1104193366 | Charles H. Shanks, D.d.s., P.C. | Preferred Provider Organization | 1511 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2011-11-16 |
| 1740278928 | Carroll Rudolph Shanks | Dentist | 1511 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2005-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659835825 | Matthew David Mallory | Physical Therapist | Morning View Village 2320 E. Lamar Alexander Parway, Maryville, TN 37804 | 2019-01-22 |
| 1063937290 | Rachel Ryan Mcmillan | Counselor | 362 High Street, Maryville, TN 37804 | 2017-08-09 |
| 1316461460 | Steven Casey Boring | Nurse Practitioner | 907 E. Lamar Alexander Pkwy., Maryville, TN 37804 | 2017-07-31 |
| 1851738751 | Robert Kane Mccall | Pathology | 250 E. Broadway, Maryville, TN 37804 | 2013-05-31 |
| 1619242849 | Jennifer Mcclements | Physical Therapy Assistant | 4004 Samuel Circle, Maryville, TN 37804 | 2012-03-21 |
| 1316223886 | Sabrina Nicole Powers | Social Worker | 1704 East Broadway, Maryville, TN 37804 | 2011-10-28 |
| 1407138381 | Russmann, Inc. | Ambulance | 4163 Benny Delozier Drive, Maryville, TN 37804 | 2011-09-15 |
| 1184932485 | Complete Family Care of Maryville, Pllc | Internal Medicine | 2004 E. Broadway, Maryville, TN 37804 | 2010-09-21 |
| 1093975096 | Kristi Clark Correll | Speech-Language Pathologist | 2030 East Lamar Alexander Parkway, Maryville, TN 37804 | 2008-06-12 |
| 1134388267 | Barbara Frantz Poulsen | Speech-Language Pathologist | 2030 E Lamar Alexander Parkway, Maryville, TN 37804 | 2008-06-04 |
| Find all providers in zip 37804 | ||||
| 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 |
|---|---|---|---|---|
| 1689657108 | Troy Randall Napier | Dentist | 1858 Crest Rd, Maryville, TN 37804-4305 | 2005-11-29 |
| 1427031947 | Otto W Slater | Dentist | 205 Southdowne Dr, Maryville, TN 37801-3747 | 2005-11-29 |
| 1295732402 | Wayne R. Witt | Dentist | 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2005-07-01 |
| 1861013195 | Tennessee Valley Oral Surgery. Pllc | Dentist | 205 Southdowne Dr, Maryville, TN 37801-3747 | 2020-04-28 |
| 1487941605 | Garren M Petree | Dentist | 1858 Crest Rd, Maryville, TN 37804-4305 | 2011-07-08 |
| 1073785010 | Brock D. Evans | Dentist | 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2008-03-31 |
| 1518151935 | Jason Robert Kennedy | Dentist | 1858 Crest Rd, Maryville, TN 37804-4305 | 2007-08-29 |
| 1093925497 | Troy A Trondson | Dentist | 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2007-05-23 |
| 1174624498 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2006-09-26 |
| 1184733446 | Southeast Oral Surgery PC | Dentist | 1858 Crest Rd, Maryville, TN 37804-4305 | 2006-08-30 |
| Find all providers in MARYVILLE | ||||
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| 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.