Provider Demographics
NPI:1215778246
Name:MITCHELL, MIKAELA ANN-MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:ANN-MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 COTTONTAIL DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1663
Mailing Address - Country:US
Mailing Address - Phone:304-685-3359
Mailing Address - Fax:
Practice Address - Street 1:3891 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2432
Practice Address - Country:US
Practice Address - Phone:304-212-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV4703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program