Provider Demographics
NPI:1255173811
Name:MIDDLESTETTER, CATHLEEN RENEE
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:RENEE
Last Name:MIDDLESTETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VIENNA CT
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1213
Mailing Address - Country:US
Mailing Address - Phone:937-369-1102
Mailing Address - Fax:
Practice Address - Street 1:7 VIENNA CT
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1213
Practice Address - Country:US
Practice Address - Phone:937-369-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.006767124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist