Healthcare Provider Details

I. General information

NPI: 1417945502
Provider Name (Legal Business Name): DAVID SHANE RASNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 YUM YUM RD
SOMERVILLE TN
38068-4541
US

IV. Provider business mailing address

138 PERKINS EXT
MEMPHIS TN
38117-3127
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-5243
  • Fax: 901-465-5245
Mailing address:
  • Phone: 901-647-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7635
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: