Provider Demographics
NPI:1942475991
Name:MITCHELL, MATTHEW L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
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 1:7500 E ANGUS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6419
Mailing Address - Country:US
Mailing Address - Phone:480-947-4636
Mailing Address - Fax:480-947-1522
Practice Address - Street 1:7500 E ANGUS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6419
Practice Address - Country:US
Practice Address - Phone:480-947-4636
Practice Address - Fax:480-947-1522
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist