Provider Demographics
NPI:1083094569
Name:VANHOOSE, MITCHELL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:VANHOOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9007
Mailing Address - Country:US
Mailing Address - Phone:740-962-6111
Mailing Address - Fax:740-962-2182
Practice Address - Street 1:716 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2836
Practice Address - Country:US
Practice Address - Phone:740-891-9000
Practice Address - Fax:740-891-9001
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30024515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist