Provider Demographics
NPI:1386785616
Name:SHANK, CHRISTOPHER LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LOUIS
Last Name:SHANK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INVERNESS DR E STE 310
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5139
Mailing Address - Country:US
Mailing Address - Phone:303-768-8977
Mailing Address - Fax:
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:#310
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-768-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190268671223G0001X
CO9899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice