Provider Demographics
NPI:1487745923
Name:MIDLIGE, JOHN FREDERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:MIDLIGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MIDVALE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1354
Mailing Address - Country:US
Mailing Address - Phone:973-263-6400
Mailing Address - Fax:973-263-5353
Practice Address - Street 1:60 MIDVALE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1354
Practice Address - Country:US
Practice Address - Phone:973-263-6400
Practice Address - Fax:973-263-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice