Provider Demographics
NPI:1447607494
Name:PRATTVILLE DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PRATTVILLE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SHEFTALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-991-0344
Mailing Address - Street 1:660 MCQUEEN SMITH RD N
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7554
Mailing Address - Country:US
Mailing Address - Phone:334-491-1725
Mailing Address - Fax:
Practice Address - Street 1:660 MCQUEEN SMITH RD N
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7554
Practice Address - Country:US
Practice Address - Phone:334-491-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty