Provider Demographics
NPI:1326001314
Name:SHIRLEY, THALIA JONIECE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THALIA
Middle Name:JONIECE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 N CENTRAL EXPY
Mailing Address - Street 2:STE. 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3425
Mailing Address - Country:US
Mailing Address - Phone:214-328-3200
Mailing Address - Fax:214-328-3178
Practice Address - Street 1:10210 N CENTRAL EXPY
Practice Address - Street 2:STE. 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3425
Practice Address - Country:US
Practice Address - Phone:214-328-3200
Practice Address - Fax:214-328-3178
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111243503Medicaid