Carroll R. Shanks, D.D.S., P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

TN2381 Issued in TN

Legal business name

CARROLL R. SHANKS, D.D.S., P.C.

Doing business as

Carroll R. Shanks, D.D.S., P.C.

Practice address

1511 E Lamar Alexander Pkwy
Maryville, TN 37804-5131

Phone

(865) 977-8048

Fax

(865) 977-0318

NPI assigned

Nov 16, 2011

Last updated

Aug 29, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

CARROLL R. SHANKS, D.D.S., P.C.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carroll Rudolph Shanks, ORAL SURGEON

Title

Owner

Phone

(865) 977-8048

Specialties & licenses 2

Addresses

Other names 1

• Carroll R. Shanks, D.D.S., P.C. Doing business as

Part of

Carroll R Shanks DDS PC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346198400000",
    "number": "1144507351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-977-8048",
            "fax_number": "865-977-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-977-8048",
            "fax_number": "865-977-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLL R. SHANKS, D.D.S., P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARROLL R. SHANKS, D.D.S., P.C.",
        "enumeration_date": "2011-11-16",
        "last_updated": "2012-08-29",
        "status": "A",
        "authorized_official_last_name": "SHANKS",
        "authorized_official_first_name": "CARROLL",
        "authorized_official_middle_name": "RUDOLPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-977-8048",
        "authorized_official_credential": "ORAL SURGEON"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "TN2381",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "TN2381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carroll R. Shanks, D.D.S., P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Ruth Carey, CRNA
• Kati Kerr Carley, APRN
• Clara Carmack, LPC
• Nathaniel Wilson Carmon, RN
• Carole L Long MD PC
• Mandee Lynn Carroll, BS
• Kristen Nicole Carver, MD
• Damian Lee Cash
• Rebecca Cassity, PHARMD
• Caughron Transport Service LLC (CTS)

• Oral and Maxillofacial Surgery (Dentist) in Maryville, TN
• Providers in Maryville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.