Provider Demographics
NPI:1689818288
Name:MITCHENER, JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MITCHENER
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 1:230 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-1318
Mailing Address - Country:US
Mailing Address - Phone:716-665-9484
Mailing Address - Fax:716-665-9485
Practice Address - Street 1:230 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-1318
Practice Address - Country:US
Practice Address - Phone:716-665-9484
Practice Address - Fax:716-665-9485
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054513-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist