Shank, John Jacob

Shank, John Jacob is an individual health care provider with primary practice located at 2121 E Dupont Rd Ste C , Fort Wayne IN 46825-1546. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Shank, John Jacob can be contacted via phone (260) 490-2013.

Contact Information

Primary practice address
2121 E Dupont Rd Ste C Fort Wayne IN 46825-1546
Phone: (260) 490-2013
Fax: (260) 490-1081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 12009584 Indiana

Profile Details

NPI number 1154349439
LBN Legal business name Shank, John Jacob
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Jan 27th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154349439 NPPES
Other 000000214282 BLUE CROSS BLUE SHIELD
Other 190009098 BLUE CROSS BLUE SHIELD
MEDICAID 200169990A BLUE CROSS BLUE SHIELD

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