Provider Demographics
NPI:1215015698
Name:MIDDLETON, GLENN ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2322 BUTANO DR
Mailing Address - Street 2:212
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0629
Mailing Address - Country:US
Mailing Address - Phone:916-486-2838
Mailing Address - Fax:916-486-0109
Practice Address - Street 1:2322 BUTANO DR
Practice Address - Street 2:212
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0629
Practice Address - Country:US
Practice Address - Phone:916-486-2838
Practice Address - Fax:916-486-0109
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice