James J Shirley, D.M.D.
Individual provider Active NPI Dentist · Freeport, FL
NPI 1962765248 · NPPES record last updated Jun 15, 2022
Key facts
- NPI
- 1962765248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN21060 (FL)
- Practice address
- 30 Blueberry Rd
Freeport, FL 32439-3016 - Phone
- (850) 835-4127
- NPI assigned
- Jun 21, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5832 CL | AL | MD | Dentist |
| DN21060 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freeport Family Dentistry, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN21060 | FL | Yes |
| Dentist | 122300000X | 5832 CL | AL |
Addresses
Primary practice location
30 Blueberry Rd
Freeport, FL 32439-3016
Mailing address
1361 Windward LN
Niceville, FL 32578-4332
Phone (850) 865-6703
Other providers in Freeport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.