Provider Demographics
NPI:1003229493
Name:MITCHELL, KENDALL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STEVENS MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2372
Mailing Address - Country:US
Mailing Address - Phone:919-736-4830
Mailing Address - Fax:919-736-7030
Practice Address - Street 1:101 STEVENS MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2372
Practice Address - Country:US
Practice Address - Phone:919-736-4830
Practice Address - Fax:919-736-7030
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice