Provider Demographics
NPI:1720128119
Name:GOLTRA, SHERYL E (DMD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:E
Last Name:GOLTRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 UNIVERSITY BLVD STE 1C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9147
Mailing Address - Country:US
Mailing Address - Phone:843-797-5133
Mailing Address - Fax:843-797-5865
Practice Address - Street 1:9217 UNIVERSITY BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9147
Practice Address - Country:US
Practice Address - Phone:843-797-5133
Practice Address - Fax:843-797-5865
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2638-03581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry