Provider Demographics
NPI:1417006891
Name:SHANKLAND, WESLEY E II (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:E
Last Name:SHANKLAND
Suffix:II
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 COMMERCE PARK DR # A
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7935
Mailing Address - Country:US
Mailing Address - Phone:614-794-0033
Mailing Address - Fax:614-794-2291
Practice Address - Street 1:158 COMMERCE PARK DR # A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7935
Practice Address - Country:US
Practice Address - Phone:614-794-0033
Practice Address - Fax:614-794-2291
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT-47449Medicare UPIN
OHSHO0506461Medicare ID - Type UnspecifiedMEDICARE