Provider Demographics
NPI:1487877221
Name:SHIRLEY, HARVEY MILES (DMD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:MILES
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 1:4509 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2815
Mailing Address - Country:US
Mailing Address - Phone:601-483-4946
Mailing Address - Fax:
Practice Address - Street 1:2400 16TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3955
Practice Address - Country:US
Practice Address - Phone:601-483-6021
Practice Address - Fax:601-483-1140
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3104-99122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist