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General NPI Number Information
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NPI Number | 1093902264
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Entity Type | Individual
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Provider Name | CHARLES H MIDDLETON DDS
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Gender | Male
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 4302 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6988
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Country | US
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Telephone | 260-484-3136
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Fax | 260-484-3137
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Provider Business Mailing Address
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Address Line | 4302 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6988
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Country | US
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Telephone | 260-484-3136
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Fax | 260-484-3137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12008119
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License Number State | IN
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