Provider Demographics
NPI:1740435668
Name:DREW MIDDLETON, DMD
Entity type:Organization
Organization Name:DREW MIDDLETON, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-450-6060
Mailing Address - Street 1:163 TURTLE CREEK DR
Mailing Address - Street 2:SUITE 80
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1284
Mailing Address - Country:US
Mailing Address - Phone:601-450-6060
Mailing Address - Fax:
Practice Address - Street 1:163 TURTLE CREEK DR
Practice Address - Street 2:SUITE 80
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1284
Practice Address - Country:US
Practice Address - Phone:601-450-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3044-981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06181398Medicaid