Provider Demographics
NPI:1144516055
Name:JETER & WELCH DENTISTRY LLC
Entity type:Organization
Organization Name:JETER & WELCH DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-797-3355
Mailing Address - Street 1:7535 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4211
Mailing Address - Country:US
Mailing Address - Phone:843-797-3355
Mailing Address - Fax:843-797-3641
Practice Address - Street 1:7535 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-797-3355
Practice Address - Fax:843-797-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty