Provider Demographics
NPI:1962607689
Name:HOUSE, MITCHEL PATRIE III (DMD)
Entity type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:PATRIE
Last Name:HOUSE
Suffix:III
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 1:1341 CLAIRMONT RD STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5311
Mailing Address - Country:US
Mailing Address - Phone:404-315-8499
Mailing Address - Fax:
Practice Address - Street 1:1341 CLAIRMONT RD STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5311
Practice Address - Country:US
Practice Address - Phone:404-315-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0107951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice