Provider Demographics
NPI:1447548151
Name:SHANK, STEPHANIE BROOKE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BROOKE
Last Name:SHANK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1700 W SMITH VALLEY RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1599
Mailing Address - Country:US
Mailing Address - Phone:317-888-9833
Mailing Address - Fax:317-885-1754
Practice Address - Street 1:1700 W SMITH VALLEY RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1599
Practice Address - Country:US
Practice Address - Phone:317-888-9833
Practice Address - Fax:317-885-1754
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011699A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics