Provider Demographics
NPI:1902321458
Name:SHURLEY, PRESTON DURHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:DURHAM
Last Name:SHURLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 INDEPENDENCE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5169
Mailing Address - Country:US
Mailing Address - Phone:770-458-3600
Mailing Address - Fax:
Practice Address - Street 1:1858 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5169
Practice Address - Country:US
Practice Address - Phone:770-458-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16501122300000X
GADN-122237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist