Provider Demographics
NPI:1346091857
Name:SPLINTER, MITCHELL LON (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:LON
Last Name:SPLINTER
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 1:600 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-2204
Mailing Address - Country:US
Mailing Address - Phone:608-778-5946
Mailing Address - Fax:
Practice Address - Street 1:206 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807-1147
Practice Address - Country:US
Practice Address - Phone:608-744-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001497-15122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program