Organization
COLUMBIA DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN SHEFTALL DMD (OWNER)
(803) 772-1548
Entity
Organization
Contact information
Practice address
2007 BROAD RIVER RD, COLUMBIA, SC 29210-7006
(803) 772-1548
Mailing address
2007 BROAD RIVER RD, COLUMBIA, SC 29210-7006
(803) 772-1548
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
200639953147
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
576571
MILLITARY
SC
05
—
Z12816
—
SC
Enumeration date
11/07/2006
Last updated
08/22/2020
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