Provider Demographics
NPI:1467782649
Name:MIDDLETON, ROSEMARIE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18924 FREEPORT DR STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4590
Mailing Address - Country:US
Mailing Address - Phone:936-582-7700
Mailing Address - Fax:936-582-7748
Practice Address - Street 1:18924 FREEPORT DR STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4590
Practice Address - Country:US
Practice Address - Phone:936-582-7700
Practice Address - Fax:936-582-7748
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics