Provider Demographics
NPI:1720183817
Name:SHIRLEY, JAMES STEVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVE
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 1:208 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-2604
Mailing Address - Country:US
Mailing Address - Phone:251-368-4679
Mailing Address - Fax:251-446-7328
Practice Address - Street 1:208 7TH AVE
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-2604
Practice Address - Country:US
Practice Address - Phone:251-368-4679
Practice Address - Fax:251-446-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL96223OtherBLUE CROSS BLUE SHIELD