Provider Demographics
NPI:1093209181
Name:MITCHELL, JENNIFER MARGARET (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARGARET
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 1:433 BOULDER RD SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7001
Mailing Address - Country:US
Mailing Address - Phone:810-348-7602
Mailing Address - Fax:
Practice Address - Street 1:2120 HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5101
Practice Address - Country:US
Practice Address - Phone:507-258-7934
Practice Address - Fax:507-322-0041
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09542122300000X
MND14153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist