Provider Demographics
NPI:1326137944
Name:SHIRLEY, BOBBY THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:THOMAS
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 1:3036 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5723
Mailing Address - Country:US
Mailing Address - Phone:770-445-6606
Mailing Address - Fax:770-443-1270
Practice Address - Street 1:3036 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5723
Practice Address - Country:US
Practice Address - Phone:770-445-6606
Practice Address - Fax:770-443-1270
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice