MEDICARE: DR. SHIRLEY JEAN CAGLE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14731	TX

General Provider Information

NPI Number	:	1598764961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY JEAN CAGLE DDS

Provider Business Mailing Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	STE A
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-681-9442
Fax Number	:	281-681-9445

Provider Business Practice Location Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	STE A
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-681-9442
Fax Number	:	281-681-9445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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