Provider Demographics
NPI:1659384238
Name:MITCHELL, LOUIS C (DDS)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:C
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 1:23 W MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2568
Mailing Address - Country:US
Mailing Address - Phone:870-295-0256
Mailing Address - Fax:
Practice Address - Street 1:23 W MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2568
Practice Address - Country:US
Practice Address - Phone:870-295-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103172608Medicaid