Provider Demographics
NPI:1629189170
Name:SHARFAE, S BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:BENJAMIN
Last Name:SHARFAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1968
Mailing Address - Country:US
Mailing Address - Phone:512-301-9002
Mailing Address - Fax:512-301-9019
Practice Address - Street 1:6001 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1968
Practice Address - Country:US
Practice Address - Phone:512-301-9002
Practice Address - Fax:512-301-9019
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist