Provider Demographics
NPI:1598883548
Name:MITCHELL, BYRON LYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:LYLE
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 1:4040 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6413
Mailing Address - Country:US
Mailing Address - Phone:972-717-1100
Mailing Address - Fax:972-717-1113
Practice Address - Street 1:4040 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6413
Practice Address - Country:US
Practice Address - Phone:972-717-1100
Practice Address - Fax:972-717-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice