Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 32150 | TX |
Y | 1223E0200X | Endodontist | 32150 | TX |
NPI | 1093262826 |
---|---|
Provider Name | Dr. Gary Gary Middleton II |
First Address | Houston, TX 77004-4980 |
Second Address | Plano, TX 75093-7868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 27/06/2019 |