Provider Demographics
NPI:1386734473
Name:MITSCH, PAUL F (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:MITSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-0567
Mailing Address - Country:US
Mailing Address - Phone:316-775-2482
Mailing Address - Fax:316-775-5068
Practice Address - Street 1:401 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1135
Practice Address - Country:US
Practice Address - Phone:316-775-2482
Practice Address - Fax:316-775-5068
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice