Provider Demographics
NPI:1699085498
Name:MITCHELL INDICTOR, D.D.S., P.A.
Entity type:Organization
Organization Name:MITCHELL INDICTOR, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:INDICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-734-8600
Mailing Address - Street 1:207 SE 23RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7653
Mailing Address - Country:US
Mailing Address - Phone:561-734-8600
Mailing Address - Fax:561-738-6672
Practice Address - Street 1:207 SE 23RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7653
Practice Address - Country:US
Practice Address - Phone:561-734-8600
Practice Address - Fax:561-738-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty