Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7635 | TN |
NPI | 1417945502 |
---|---|
Provider Name | Dr. David Shane Rasner |
First Address | Memphis, TN 38117-3127 |
Second Address | Somerville, TN 38068-4541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |