Provider Demographics
NPI:1639682669
Name:SHANKS DENTISTRY
Entity Type:Organization
Organization Name:SHANKS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-982-1700
Mailing Address - Street 1:904 WEST BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty