Provider Demographics
NPI:1366603003
Name:MIDDLETON, PHILIP ADAM (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ADAM
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-4734
Mailing Address - Country:US
Mailing Address - Phone:662-231-6911
Mailing Address - Fax:662-289-7050
Practice Address - Street 1:101 RIDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3265
Practice Address - Country:US
Practice Address - Phone:662-289-7076
Practice Address - Fax:662-289-7050
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3470081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice