Provider Demographics
NPI:1720077449
Name:MITCHELL, ALVAN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALVAN
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 S HARRISON ST
Mailing Address - Street 2:SUITTE 1N
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1218
Mailing Address - Country:US
Mailing Address - Phone:973-673-8688
Mailing Address - Fax:973-673-1119
Practice Address - Street 1:377 S HARRISON ST
Practice Address - Street 2:SUITTE 1N
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1218
Practice Address - Country:US
Practice Address - Phone:973-673-8688
Practice Address - Fax:973-673-1119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018057001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice