Provider Demographics
NPI:1023556230
Name:KISHA STEELE MITCHELL DDS PC
Entity Type:Organization
Organization Name:KISHA STEELE MITCHELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:STEELE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-948-8494
Mailing Address - Street 1:10115 HICKORYWOOD HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3422
Mailing Address - Country:US
Mailing Address - Phone:704-948-8494
Mailing Address - Fax:704-948-8482
Practice Address - Street 1:10115 HICKORYWOOD HILL AVE
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3422
Practice Address - Country:US
Practice Address - Phone:704-948-8494
Practice Address - Fax:704-948-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10006451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty