Provider Demographics
NPI:1689787053
Name:MITCHELL, WILLIAM CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
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 1:1631 WETZEL AVENUE, BLDG 815
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-526-5551
Practice Address - Street 1:1631 WETZEL AVENUE, BLDG 815
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:719-526-5551
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104893122300000X
CODEN-100641223G0001X
WI50016971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist