Healthcare Provider Details

I. General information

NPI: 1386785616
Provider Name (Legal Business Name): CHRISTOPHER LOUIS SHANK D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INVERNESS DR E #310
ENGLEWOOD CO
80112-5137
US

IV. Provider business mailing address

125 INVERNESS DR E STE 310
ENGLEWOOD CO
80112-5139
US

V. Phone/Fax

Practice location:
  • Phone: 303-768-8977
  • Fax:
Mailing address:
  • Phone: 303-768-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9899
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19026867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: