Provider Demographics
NPI:1598924342
Name:SHIRLEY, ANNA JOY WINDHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JOY WINDHAM
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:JOY
Other - Last Name:WINDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
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:936-055-1553
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:75965-1250
Practice Address - Country:US
Practice Address - Phone:936-055-1553
Practice Address - Fax:936-305-5322
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice