Provider Demographics
NPI:1700997756
Name:MITCHELL, VINCE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCE
Middle Name:EDWARD
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 1:43038 NEBEL TRL
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2458
Mailing Address - Country:US
Mailing Address - Phone:586-285-5200
Mailing Address - Fax:
Practice Address - Street 1:29820 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2644
Practice Address - Country:US
Practice Address - Phone:586-285-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice