Provider Demographics
NPI:1720490063
Name:MITCHELL, SHAWN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
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 1:4950 CENTRE POINTE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6929
Mailing Address - Country:US
Mailing Address - Phone:843-823-6530
Mailing Address - Fax:
Practice Address - Street 1:4950 CENTRE POINTE DR STE 114
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6929
Practice Address - Country:US
Practice Address - Phone:843-823-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88631223G0001X
TN103351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice