Provider Demographics
NPI:1649307836
Name:BRIAN P MIDGETTE DDS PC
Entity type:Organization
Organization Name:BRIAN P MIDGETTE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MIDGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-483-4700
Mailing Address - Street 1:3326 TAYLOR ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2518
Mailing Address - Country:US
Mailing Address - Phone:757-483-4700
Mailing Address - Fax:757-483-2359
Practice Address - Street 1:3326 TAYLOR ROAD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2518
Practice Address - Country:US
Practice Address - Phone:757-483-4700
Practice Address - Fax:757-483-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006913122300000X
VA0401004372122300000X
VA0401411578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty