Individual
BETHANY MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
2534 FARRAGUT DR, SPRINGFIELD, IL 62704-1457
(217) 546-4674
Mailing address
2534 FARRAGUT DR, SPRINGFIELD, IL 62704-1457
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019029349
IL
Other
Enumeration date
11/10/2014
Last updated
11/10/2014
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