MEDICARE: DR. BENJAMIN FRANKLIN SHEFTALL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1964	SC

General Provider Information

NPI Number	:	1245245638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN FRANKLIN SHEFTALL DMD

Provider Business Mailing Address
First Line	:	664 HARBOR CREEK PL
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3203
Country	:	US
Telephone Number	:	843-406-9554
Fax Number	:	843-762-0448

Provider Business Practice Location Address
First Line	:	664 HARBOR CREEK PL
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3203
Country	:	US
Telephone Number	:	843-406-9554
Fax Number	:	843-762-0448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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