Provider Demographics
NPI:1689875866
Name:MITCHELL, BRIAN DENNIS (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DENNIS
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 1:3031 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2764
Mailing Address - Country:US
Mailing Address - Phone:614-875-2153
Mailing Address - Fax:614-875-7471
Practice Address - Street 1:3031 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2764
Practice Address - Country:US
Practice Address - Phone:614-875-2153
Practice Address - Fax:614-875-7471
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0214001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice