Provider Demographics
NPI:1891918512
Name:SHIRLEY, ASA DUNCAN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASA
Middle Name:DUNCAN
Last Name:SHIRLEY
Suffix:III
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 1:28 S MAIN ST
Mailing Address - Street 2:P. O. BOX 987
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1810
Mailing Address - Country:US
Mailing Address - Phone:864-834-8001
Mailing Address - Fax:864-834-5563
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1810
Practice Address - Country:US
Practice Address - Phone:864-834-8001
Practice Address - Fax:864-834-5563
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ18632Medicaid