Provider Demographics
NPI:1467624973
Name:SHIRLEY, BRETT MCCANN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:MCCANN
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:DDS, MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
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:936-305-5155
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
Practice Address - Country:US
Practice Address - Phone:936-305-5155
Practice Address - Fax:936-305-5322
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA2077961223S0112X
TX239351223S0112X
TXQ08291223S0112X
AZ502031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery