Provider Demographics
NPI:1972645323
Name:SHANKER, BENNETT RORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:RORY
Last Name:SHANKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8849
Mailing Address - Country:US
Mailing Address - Phone:609-268-9292
Mailing Address - Fax:
Practice Address - Street 1:1583 ROUTE 206
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-8849
Practice Address - Country:US
Practice Address - Phone:609-268-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ146731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice