Provider Demographics
NPI:1205062601
Name:MITCHELL, BRANDON THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:THOMAS
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:HC 70 BOX 2B
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26815-9603
Mailing Address - Country:US
Mailing Address - Phone:304-249-5935
Mailing Address - Fax:
Practice Address - Street 1:161 SOUTH BRANCH STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807
Practice Address - Country:US
Practice Address - Phone:304-358-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice