Provider Demographics
NPI:1417406323
Name:MITCHELL, BARRY (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
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 1:2660 CYPRESS PT
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1244
Mailing Address - Country:US
Mailing Address - Phone:310-600-3123
Mailing Address - Fax:
Practice Address - Street 1:2660 CYPRESS PT
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1244
Practice Address - Country:US
Practice Address - Phone:310-600-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist