Organization
EASTSIDE FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY WARING SHEFTALL JR. DMD (PRESIDENT)
(864) 261-3132
Entity
Organization
Contact information
Practice address
3620 EAST RIVER ST, ANDERSON, SC 29621-7334
(864) 261-3132
(864) 261-6614
Mailing address
3620 EAST RIVER ST, ANDERSON, SC 29621-7334
(864) 261-3132
(864) 261-6614
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2891
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2X2891
—
SC
Enumeration date
09/06/2006
Last updated
08/27/2008
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