Provider Demographics
NPI:1629284401
Name:MITCHELL DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:MITCHELL DENTAL CLINIC LLC
Other - Org Name:THE DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DORSAY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WINTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-996-7786
Mailing Address - Street 1:1920 NORTH KIMBALL
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301
Mailing Address - Country:US
Mailing Address - Phone:605-996-7786
Mailing Address - Fax:605-996-7786
Practice Address - Street 1:1920 NORTH KIMBALL
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301
Practice Address - Country:US
Practice Address - Phone:605-996-7786
Practice Address - Fax:605-996-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM379122300000X
SDM838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty