Provider Demographics
NPI:1699915686
Name:MIDDLETON, MANUEL R (DDS)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:R
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 COUNTY ROAD 101
Mailing Address - Street 2:SUITE 104
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9332
Mailing Address - Country:US
Mailing Address - Phone:352-259-4297
Mailing Address - Fax:352-259-3705
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:SUITE 104
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-259-4297
Practice Address - Fax:352-259-3705
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-106071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN10607OtherLICENSE NUMBER
FLDN10607OtherLICENSE NUMBER