Provider Demographics
NPI:1902008378
Name:MIDDLETON, JOHN HICKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HICKS
Last Name:MIDDLETON
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 1:4970 S 900 E STE E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5796
Mailing Address - Country:US
Mailing Address - Phone:801-403-5723
Mailing Address - Fax:801-266-0225
Practice Address - Street 1:4970 S 900 E STE E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5796
Practice Address - Country:US
Practice Address - Phone:801-266-7351
Practice Address - Fax:801-266-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5146432-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice