Provider Demographics
NPI:1013055797
Name:AFFORDABLE DENTURES -TERRE HAUTE,P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES -TERRE HAUTE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-877-6724
Mailing Address - Street 1:2801 S ANTON ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9747
Mailing Address - Country:US
Mailing Address - Phone:812-877-6724
Mailing Address - Fax:
Practice Address - Street 1:2801 S ANTON ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9747
Practice Address - Country:US
Practice Address - Phone:812-877-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010393A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty