Provider Demographics
NPI:1891914586
Name:MITCHELL, DOUGLAS S (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2899
Mailing Address - Country:US
Mailing Address - Phone:510-865-4551
Mailing Address - Fax:510-865-6301
Practice Address - Street 1:2145 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2899
Practice Address - Country:US
Practice Address - Phone:510-865-4551
Practice Address - Fax:510-865-6301
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice