Provider Demographics
NPI:1356533558
Name:MITCHELL, JAMILA A (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMILA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
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:PO BOX 13934
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-3934
Mailing Address - Country:US
Mailing Address - Phone:337-365-5078
Mailing Address - Fax:337-365-5078
Practice Address - Street 1:1218 DILLARD ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-0834
Practice Address - Country:US
Practice Address - Phone:337-365-5078
Practice Address - Fax:337-365-5078
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist