Provider Demographics
NPI:1982797627
Name:MIDKIFF, PETER DYLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DYLAN
Last Name:MIDKIFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MECHEM DR.
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345
Mailing Address - Country:US
Mailing Address - Phone:505-257-1136
Mailing Address - Fax:505-257-0923
Practice Address - Street 1:700 MECHEM DR.
Practice Address - Street 2:SUITE 8
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345
Practice Address - Country:US
Practice Address - Phone:505-257-1136
Practice Address - Fax:505-257-0923
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD20221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice