Provider Demographics
NPI:1356417992
Name:WILLIAM E MIDDLETON JR DDS PA
Entity type:Organization
Organization Name:WILLIAM E MIDDLETON JR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:662-342-6530
Mailing Address - Street 1:3011 GOODMAN ROAD W
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637
Mailing Address - Country:US
Mailing Address - Phone:662-342-6530
Mailing Address - Fax:662-342-9098
Practice Address - Street 1:3011 GOODMAN ROAD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637
Practice Address - Country:US
Practice Address - Phone:662-342-6530
Practice Address - Fax:662-342-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS259290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty