Provider Demographics
NPI:1821390105
Name:MITCHELL AND BARTLETT ORTHODONTICS
Entity Type:Organization
Organization Name:MITCHELL AND BARTLETT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-855-8900
Mailing Address - Street 1:5314 W FRIENDLY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4351
Mailing Address - Country:US
Mailing Address - Phone:336-855-8900
Mailing Address - Fax:336-855-0183
Practice Address - Street 1:5314 W FRIENDLY AVE STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4351
Practice Address - Country:US
Practice Address - Phone:336-855-8900
Practice Address - Fax:336-855-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty