Provider Demographics
NPI:1316012750
Name:MITCHELL, KATHLEEN ALICE (RDH)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ALICE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MITCHELL
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:20219 MAPLE LEAF STREET
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013
Mailing Address - Country:US
Mailing Address - Phone:530-335-2141
Mailing Address - Fax:
Practice Address - Street 1:36977 PARK AVE
Practice Address - Street 2:PIT RIVER HEATH SERVICE
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013
Practice Address - Country:US
Practice Address - Phone:530-335-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH8266124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist