Basic Information
| Provider Information | |||||||||
| NPI: | 1982754461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDDLETON | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 W. 18TH STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135260555 | ||||||||
| FaxNumber: | 7135261422 | ||||||||
| Practice Location | |||||||||
| Address1: | 1427 HAWTHORNE ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135296071 | ||||||||
| FaxNumber: | 7135261422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 20834 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.