Provider Demographics
NPI:1508875923
Name:MIDEI, BRIAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:MIDEI
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 1:901 S CROCKETT AVE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950-7837
Mailing Address - Country:US
Mailing Address - Phone:520-730-9232
Mailing Address - Fax:520-579-6426
Practice Address - Street 1:901 S CROCKETT AVE STE 137
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-7837
Practice Address - Country:US
Practice Address - Phone:520-730-9232
Practice Address - Fax:520-579-6665
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZD5377122300000X
TX324931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist