Provider Demographics
NPI:1316216716
Name:MIDDLETON & BELKNAP PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:MIDDLETON & BELKNAP PEDIATRIC DENTISTRY PLLC
Other - Org Name:PEDIATRIC DENTAL GROUP OF HATTIESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-450-6060
Mailing Address - Street 1:6643 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8442
Mailing Address - Country:US
Mailing Address - Phone:601-450-6060
Mailing Address - Fax:601-450-6062
Practice Address - Street 1:6643 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8442
Practice Address - Country:US
Practice Address - Phone:601-450-6060
Practice Address - Fax:601-450-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty