Provider Demographics
NPI:1992175376
Name:ELIZABETH G MITCHELL, DDS, LLC
Entity type:Organization
Organization Name:ELIZABETH G MITCHELL, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-409-1617
Mailing Address - Street 1:6750 POPLAR AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7438
Mailing Address - Country:US
Mailing Address - Phone:901-756-1151
Mailing Address - Fax:901-756-1575
Practice Address - Street 1:6750 POPLAR AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7438
Practice Address - Country:US
Practice Address - Phone:901-756-1151
Practice Address - Fax:901-756-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty