Provider Demographics
NPI:1528684206
Name:BRIAN MIDGETTE, DDS, PLLC
Entity type:Organization
Organization Name:BRIAN MIDGETTE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIDGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-773-2122
Mailing Address - Street 1:8804 PATTERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6361
Mailing Address - Country:US
Mailing Address - Phone:804-740-7212
Mailing Address - Fax:
Practice Address - Street 1:8804 PATTERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6361
Practice Address - Country:US
Practice Address - Phone:804-740-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033246210OtherNPI