Provider Demographics
NPI:1851461115
Name:MITCHELL, JANE ELLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 OCEAN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1942
Mailing Address - Country:US
Mailing Address - Phone:718-783-2260
Mailing Address - Fax:718-252-3228
Practice Address - Street 1:1170 OCEAN AVE
Practice Address - Street 2:STE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1942
Practice Address - Country:US
Practice Address - Phone:718-783-2260
Practice Address - Fax:718-252-3228
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00725897Medicaid