Provider Demographics
NPI:1801414891
Name:SHANKLE, MORGAN D (DMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:
Practice Address - Street 1:1036 S VERITY PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5513
Practice Address - Country:US
Practice Address - Phone:513-454-1460
Practice Address - Fax:513-737-1592
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10547122300000X
OH30.0266831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0465390Medicaid