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General NPI Number Information
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NPI Number | 1134588189
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Entity Type | Organization
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Legal Business Name | GERALD M MIDDLETON, DDS, INC.
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 4234 RIVERWALK PKWY STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92505-3304
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Country | US
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Telephone | 951-688-3442
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Fax |
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Provider Business Mailing Address
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Address Line | 4234 RIVERWALK PKWY STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92505-3304
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Country | US
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Telephone | 951-688-3442
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GERALD MICHAEL MIDDLETON
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Credential | DDS
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Telephone | 951-688-3442
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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 | 39309
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License Number State | CA
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