Individual
DR. CHARLES H MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4302 E STATE BLVD, FORT WAYNE, IN 46815-6988
(260) 484-3136
(260) 484-3137
Mailing address
4302 E STATE BLVD, FORT WAYNE, IN 46815-6988
(260) 484-3136
(260) 484-3137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008119
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055165
UNITED CONCORDIA
IN
05
—
100079660A
—
IN
Enumeration date
10/01/2007
Last updated
03/31/2016
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