Provider Demographics
NPI:1194202051
Name:MITCHELL, EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 THE AMERICAN RD SE STE 369
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1858
Mailing Address - Country:US
Mailing Address - Phone:505-898-6000
Mailing Address - Fax:505-898-6166
Practice Address - Street 1:2600 THE AMERICAN RD SE STE 369
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1858
Practice Address - Country:US
Practice Address - Phone:505-898-6000
Practice Address - Fax:505-890-6166
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2023-0212122300000X
WADE60874699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist