Provider Demographics
NPI:1134609829
Name:MITCHELL, SHAWN ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANTHONY
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 1:510 GLYNN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2828
Mailing Address - Country:US
Mailing Address - Phone:757-897-7012
Mailing Address - Fax:
Practice Address - Street 1:1480 QUARTERPATH RD STE 2A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6531
Practice Address - Country:US
Practice Address - Phone:757-345-2295
Practice Address - Fax:757-345-6336
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist