Healthcare Provider Details

I. General information

NPI: 1306461165
Provider Name (Legal Business Name): WILLIAMD. MIDDLETON, DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 HIGHWAY 327 E
SILSBEE TX
77656-5120
US

IV. Provider business mailing address

1164 HIGHWAY 327 E
SILSBEE TX
77656-5120
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-3651
  • Fax: 409-385-9456
Mailing address:
  • Phone: 409-385-3651
  • Fax: 409-385-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM D. MIDDLETON
Title or Position: PRESIDENT
Credential: DDS
Phone: 409-385-3651