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General NPI Number Information
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NPI Number | 1447661186
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Entity Type | Organization
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Legal Business Name | DR. EDWIN KENT SHIRLEY
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 1231 27TH ST S STE B
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City | FARGO
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State | ND
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Zip | 58103-8722
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Country | US
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Telephone | 701-235-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 1231 27TH ST S STE B
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City | FARGO
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State | ND
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Zip | 58103-8722
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Country | US
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Telephone | 701-235-8402
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF DENTAL SURGERY
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Name | DR. EDWIN KENT SHIRLEY
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Credential | DDS
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Telephone | 701-235-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1596
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License Number State | ND
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