Provider Demographics
NPI:1689975237
Name:DR. NICOLE A. MIDDLETON, PSC
Entity Type:Organization
Organization Name:DR. NICOLE A. MIDDLETON, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:270-393-4814
Mailing Address - Street 1:2425 SCOTTSVILLE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4457
Mailing Address - Country:US
Mailing Address - Phone:270-393-4814
Mailing Address - Fax:270-842-5581
Practice Address - Street 1:2425 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4457
Practice Address - Country:US
Practice Address - Phone:270-393-4814
Practice Address - Fax:270-842-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty