Provider Demographics
NPI:1962947739
Name:BRIAN MIDEI DDS PLLC
Entity type:Organization
Organization Name:BRIAN MIDEI DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-730-9232
Mailing Address - Street 1:901 S CROCKETT AVE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950-7837
Mailing Address - Country:US
Mailing Address - Phone:520-730-9232
Mailing Address - Fax:
Practice Address - Street 1:901 S CROCKETT AVE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-7837
Practice Address - Country:US
Practice Address - Phone:520-730-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32492261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental