Provider Demographics
NPI:1215464060
Name:MIDTLING, CHRISTOPHER S (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:MIDTLING
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2004
Mailing Address - Country:US
Mailing Address - Phone:281-367-2001
Mailing Address - Fax:
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2004
Practice Address - Country:US
Practice Address - Phone:281-367-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404091223S0112X, 122300000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program