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John Jacob Shank, DDS
Oral and Maxillofacial Surgery (Dentist) in Fort Wayne, Indiana
NPI 1154349439

John Jacob Shank is a Oral and Maxillofacial Surgery (Dentist) based in Fort Wayne, IN and is specialized in Oral and Maxillofacial Surgery. John Jacob Shank practices in Fort Wayne, IN and has the professional credentials of DDS. The NPI Number for John Jacob Shank is 1154349439 and holds a License No. 12009584 (Indiana).

The current practice location address for John Jacob Shank is 2121 E Dupont Rd Ste C, Fort Wayne, IN and can be reached out via phone at 260-490-2013 and via fax at 260-490-1081. You can also correspond with John Jacob Shank through the mailing address at 2121 E DUPONT RD STE C, FORT WAYNE, IN - 46825-1546 (mailing address contact number: 260-490-2013).

Location: 2121 E Dupont Rd Ste C, Fort Wayne, IN, 46825-1546
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1154349439
Provider Name
John Jacob Shank
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
2121 E Dupont Rd Ste C, Fort Wayne, IN, 46825-1546
Phone Number
260-490-2013
Fax Number
260-490-1081
Provider Enumeration Date
07/17/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000000214282 01 BLUE CROSS BLUE SHIELD
190009098 01 RAILROAD MEDICARE
200169990A 05 IN
institution
Provider Business Practice Location Address Details
Address
2121 E Dupont Rd Ste C
City
Fort Wayne
State
Indiana
Zip
46825-1546
Phone Number
260-490-2013
Fax Number
260-490-1081
person
Provider Business Mailing Address Details
Address
2121 E Dupont Rd Ste C
City
Fort Wayne
State
Indiana
Zip
46825-1546
Phone Number
260-490-2013
Fax Number
260-490-1081
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
12009584 (Indiana)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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