Provider Demographics
NPI:1437328564
Name:MITCHELL/ZAW DENTAL CORPORATION
Entity Type:Organization
Organization Name:MITCHELL/ZAW DENTAL CORPORATION
Other - Org Name:OAK VALLEY PLAZA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-849-6300
Mailing Address - Street 1:892 OAK VALLEY PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223
Mailing Address - Country:US
Mailing Address - Phone:951-849-6300
Mailing Address - Fax:951-849-0076
Practice Address - Street 1:892 OAK VALLEY PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-849-6300
Practice Address - Fax:951-849-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty