Provider Demographics
NPI:1063430676
Name:LOMKE, MITCHELL ARLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ARLEN
Last Name:LOMKE
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 1:18109 PRINCE PHILIP DRIVE
Mailing Address - Street 2:#355
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1599
Mailing Address - Country:US
Mailing Address - Phone:301-260-0700
Mailing Address - Fax:301-260-1500
Practice Address - Street 1:18109 PRINCE PHILIP DRIVE
Practice Address - Street 2:SUITE# 355
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice