Provider Demographics
NPI:1598876351
Name:SHIRLEY, CEDRIC LEVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:LEVI
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2104
Mailing Address - Country:US
Mailing Address - Phone:417-678-4141
Mailing Address - Fax:
Practice Address - Street 1:1402 S ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2104
Practice Address - Country:US
Practice Address - Phone:417-678-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050301581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice