Provider Demographics
NPI:1417967597
Name:MITCHELL, LOWELL G JR
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:G
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KENTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47951-1135
Mailing Address - Country:US
Mailing Address - Phone:219-474-5059
Mailing Address - Fax:219-474-3544
Practice Address - Street 1:310 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KENTLAND
Practice Address - State:IN
Practice Address - Zip Code:47951-1135
Practice Address - Country:US
Practice Address - Phone:219-474-5059
Practice Address - Fax:219-474-3544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice