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General NPI Number Information
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NPI Number | 1013055797
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES -TERRE HAUTE,P.C.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 S ANTON ST
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9747
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Country | US
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Telephone | 812-877-6724
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 S ANTON ST
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9747
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Country | US
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Telephone | 812-877-6724
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLEN MIDDAUGH
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Credential | DDS
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Telephone | 812-877-6724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010393A
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License Number State | IN
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