Provider Demographics
NPI:1376773879
Name:SHANKS, SARAH B (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:B
Last Name:SHANKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4637
Mailing Address - Country:US
Mailing Address - Phone:865-233-7640
Mailing Address - Fax:865-233-7660
Practice Address - Street 1:904 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4637
Practice Address - Country:US
Practice Address - Phone:865-233-7640
Practice Address - Fax:865-233-7660
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist