Provider Demographics
NPI:1255457214
Name:J J MITCHELL DENTAL GROUP
Entity type:Organization
Organization Name:J J MITCHELL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:C,
Authorized Official - Last Name:SAFFOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-955-0355
Mailing Address - Street 1:1525 E 53RD ST
Mailing Address - Street 2:SUITE 821
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:773-955-0355
Mailing Address - Fax:773-955-1175
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 821
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-955-0355
Practice Address - Fax:773-955-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-193401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty