Individual
GLEN D MIDDAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2801 ANTON ROAD, TERRE HAUTE, IN 47803
(812) 877-6724
(812) 877-6150
Mailing address
2801 ANTON ROAD, TERRE HAUTE, IN 47803
(812) 877-6724
(812) 877-6150
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010393
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200415160A
—
IN
Enumeration date
06/16/2005
Last updated
11/18/2014
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