Provider Demographics
NPI:1891264024
Name:BRETT SHIRLEY DDS MD PLLC
Entity type:Organization
Organization Name:BRETT SHIRLEY DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:936-305-5155
Mailing Address - Street 1:4800 NE STALLINGS DR STE 113
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1250
Mailing Address - Country:US
Mailing Address - Phone:936-657-0120
Mailing Address - Fax:936-305-5322
Practice Address - Street 1:4800 NE STALLINGS DR STE 113
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1250
Practice Address - Country:US
Practice Address - Phone:936-657-0120
Practice Address - Fax:936-305-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty