Provider Demographics
NPI:1982820064
Name:SHANKLIN, GEOFFREY NOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:NOEL
Last Name:SHANKLIN
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 1:1122 N BRAND BLVD
Mailing Address - Street 2:#202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2547
Mailing Address - Country:US
Mailing Address - Phone:818-242-1372
Mailing Address - Fax:
Practice Address - Street 1:1122 N BRAND BLVD
Practice Address - Street 2:#202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2547
Practice Address - Country:US
Practice Address - Phone:818-242-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice