Provider Demographics
NPI:1821116799
Name:MITCHELL, STEVEN ALLGOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLGOOD
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 1:105 CARNEGIE PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3980
Mailing Address - Country:US
Mailing Address - Phone:770-460-2120
Mailing Address - Fax:770-460-2215
Practice Address - Street 1:105 CARNEGIE PL
Practice Address - Street 2:SUITE 109
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3980
Practice Address - Country:US
Practice Address - Phone:770-460-2120
Practice Address - Fax:770-460-2215
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0115271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice