Provider Demographics
NPI:1467549469
Name:ESIANOR-MITCHUAL, ETHEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:A
Last Name:ESIANOR-MITCHUAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 MARIETTA AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3239
Mailing Address - Country:US
Mailing Address - Phone:717-393-5055
Mailing Address - Fax:717-393-5676
Practice Address - Street 1:822 MARIETTA AVE STE 21
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3239
Practice Address - Country:US
Practice Address - Phone:717-393-5055
Practice Address - Fax:717-393-5676
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029950L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000183384OtherDENTISTRY