Provider Demographics
NPI:1053325167
Name:MITCHELL, PHILLIP ANTHONY (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 HIGHWAY 280
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6585
Mailing Address - Country:US
Mailing Address - Phone:205-980-9000
Mailing Address - Fax:205-980-1399
Practice Address - Street 1:5511 HIGHWAY 280
Practice Address - Street 2:SUITE 118
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6585
Practice Address - Country:US
Practice Address - Phone:205-980-9000
Practice Address - Fax:205-980-1399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL037871223S0112X
AL17041204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL06576OtherBCBS # OF AL
ALT93636Medicare UPIN