Provider Demographics
NPI:1346338514
Name:MITCHELL, ROBERT LEVIS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEVIS
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:LEVIS
Other - Last Name:MITCHELL
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3508 FAR WEST BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3041
Mailing Address - Country:US
Mailing Address - Phone:512-346-4454
Mailing Address - Fax:512-346-4595
Practice Address - Street 1:3508 FAR WEST BOULEVARD
Practice Address - Street 2:SUITE 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3041
Practice Address - Country:US
Practice Address - Phone:512-346-4454
Practice Address - Fax:512-346-4595
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice