Provider Demographics
NPI:1962765248
Name:SHIRLEY, JAMES J (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4332
Mailing Address - Country:US
Mailing Address - Phone:850-865-6703
Mailing Address - Fax:
Practice Address - Street 1:30 BLUEBERRY RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3016
Practice Address - Country:US
Practice Address - Phone:850-835-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21060122300000X
AL5832 CL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist