Provider Demographics
NPI:1619039336
Name:MITCHELL, ALBERT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:B
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 1:4700 WISSAHICKON AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3600
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:6120B WOODLAND AVE #2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-727-4721
Practice Address - Fax:267-350-5932
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPADS026092-L1223G0001X
PADS026092L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001135605Medicaid