Provider Demographics
NPI:1245245638
Name:SHEFTALL, BENJAMIN FRANKLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FRANKLIN
Last Name:SHEFTALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 HARBOR CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3203
Mailing Address - Country:US
Mailing Address - Phone:843-406-9554
Mailing Address - Fax:843-762-0448
Practice Address - Street 1:664 HARBOR CREEK PL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3203
Practice Address - Country:US
Practice Address - Phone:843-406-9554
Practice Address - Fax:843-762-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice