Provider Demographics
NPI:1457507683
Name:MARK D. SHIRLEY,DDS, PC
Entity Type:Organization
Organization Name:MARK D. SHIRLEY,DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-691-0877
Mailing Address - Street 1:13316 S WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7302
Mailing Address - Country:US
Mailing Address - Phone:405-691-0877
Mailing Address - Fax:405-691-1551
Practice Address - Street 1:13316 S WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7302
Practice Address - Country:US
Practice Address - Phone:405-691-0877
Practice Address - Fax:405-691-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty