Provider Demographics
NPI:1851437297
Name:MITCHELL, DAMANI MUATA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMANI
Middle Name:MUATA
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 1:3600 GUARD RD
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2705
Mailing Address - Country:US
Mailing Address - Phone:805-736-4154
Mailing Address - Fax:
Practice Address - Street 1:3600 GUARD RD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2705
Practice Address - Country:US
Practice Address - Phone:805-736-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice