Provider Demographics
NPI:1528263696
Name:BRIAN MIDEI D.D.S.,P.C.
Entity type:Organization
Organization Name:BRIAN MIDEI D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MIDEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-744-6423
Mailing Address - Street 1:8295 N CORTARO RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7442
Mailing Address - Country:US
Mailing Address - Phone:520-744-6423
Mailing Address - Fax:520-579-6665
Practice Address - Street 1:8295 N CORTARO RD
Practice Address - Street 2:SUITE 137
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7442
Practice Address - Country:US
Practice Address - Phone:520-744-6423
Practice Address - Fax:520-579-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1508875923OtherNPI TYPE 1