Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4809 | NC |
NPI | 1104967041 |
---|---|
Provider Name | Dr. Glenn J. Shefter |
First Address | Hendersonville, NC 28792-2301 |
Second Address | Hendersonville, NC 28792-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |