Provider Demographics
NPI:1376752261
Name:MITCHELL, JASON CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3282
Mailing Address - Country:US
Mailing Address - Phone:864-226-8272
Mailing Address - Fax:864-964-9538
Practice Address - Street 1:2713 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3282
Practice Address - Country:US
Practice Address - Phone:864-226-8272
Practice Address - Fax:864-964-9538
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3611Medicaid