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NPI Code Detail

MEDICARE: DR. GERALD MICHAEL MIDDLETON DDS

MEDICARE: DR. GERALD MICHAEL MIDDLETON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry39309CA

General Provider Information

NPI Number : 1669543765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALD MICHAEL MIDDLETON DDS
Provider Business Mailing Address
First Line : 2572 CENTENNIAL WAY
Second Line :
City : CORONA
State : CA
Zip : 92882-5746
Country : US
Telephone Number : 951-688-3442
Fax Number : 951-688-4744
Provider Business Practice Location Address
First Line : 4234 RIVERWALK PKWY
Second Line : SUITE 100
City : RIVERSIDE
State : CA
Zip : 92505-3304
Country : US
Telephone Number : 951-688-3442
Fax Number : 951-688-4744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2006
Last Update Date : 05/28/2010

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