Provider Demographics
NPI:1912174962
Name:MITCHELL AND MITCHELL DDS PC
Entity type:Organization
Organization Name:MITCHELL AND MITCHELL DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-285-5200
Mailing Address - Street 1:29820 HARPER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2644
Mailing Address - Country:US
Mailing Address - Phone:586-285-5200
Mailing Address - Fax:586-285-5400
Practice Address - Street 1:29820 HARPER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2644
Practice Address - Country:US
Practice Address - Phone:586-285-5200
Practice Address - Fax:586-285-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty