Provider Demographics
NPI:1497249965
Name:MACTIER, MITCHELL C (DDS)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:C
Last Name:MACTIER
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 1:600 N SHEPHERD DR STE 164
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4652
Mailing Address - Country:US
Mailing Address - Phone:281-768-8922
Mailing Address - Fax:
Practice Address - Street 1:600 N SHEPHERD DR STE 164
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-4652
Practice Address - Country:US
Practice Address - Phone:281-768-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice