Provider Demographics
NPI:1205042561
Name:MITCHELL, JAMES R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-0506
Mailing Address - Country:US
Mailing Address - Phone:940-495-3555
Mailing Address - Fax:
Practice Address - Street 1:609 WEST FRONT STREET
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-0506
Practice Address - Country:US
Practice Address - Phone:940-495-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice