John Van Bradley Shanks, D.D.S.
Individual provider Active NPI General Practice Dentistry · Pikeville, TN
NPI 1881906360 · NPPES record last updated Jul 13, 2010
Key facts
- NPI
- 1881906360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9128 (TN)
- Practice address
- 3086 Main Street
Pikeville, TN 37367 - Phone
- (423) 447-2421
- Fax
- (423) 447-3408
- NPI assigned
- Jul 13, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9128 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pikeville Family Dentistry | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9128 | TN | Yes |
Addresses
Primary practice location
3086 Main Street
Pikeville, TN 37367
Mailing address
3086 Main Street
Pikeville, TN 37367
Phone (423) 447-2421
Other providers in Pikeville, TN
- Amie Sims Rainey
- Rylee Elyn Reece
- Sonja Renfroe
- Shirley Rogers
- Eva Sawyer
- Troy David Simpson
- Skills Training and Rehabilitation Services
- Michael Smith
- Tony Dwayne Smith
- Dorothy Spafford
All providers in Pikeville, TN · General Practice Dentistry in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.