Provider Demographics
NPI:1669628483
Name:MITCHELL, JONATHAN MARK (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARK
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-1466
Mailing Address - Country:US
Mailing Address - Phone:843-537-9044
Mailing Address - Fax:
Practice Address - Street 1:3137 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-6633
Practice Address - Country:US
Practice Address - Phone:843-537-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist