Provider Demographics
NPI:1225799356
Name:DR. ESIANOR-MITCHUAL DENTAL, PC
Entity Type:Organization
Organization Name:DR. ESIANOR-MITCHUAL DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESIANOR-MITCHUAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-393-5055
Mailing Address - Street 1:822 MARIETTA AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3239
Mailing Address - Country:US
Mailing Address - Phone:717-393-5055
Mailing Address - Fax:
Practice Address - Street 1:822 MARIETTA AVE STE 21
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3239
Practice Address - Country:US
Practice Address - Phone:717-393-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty