Provider Demographics
NPI:1851483937
Name:MITCHELL, KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3114 N OCONNOR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-252-3020
Mailing Address - Fax:972-252-3050
Practice Address - Street 1:3114 N OCONNOR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-252-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX15354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist