Provider Demographics
NPI:1740692490
Name:MITCHELL, BRYAN MARK (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MARK
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HERMANN DR STE 845
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7027
Mailing Address - Country:US
Mailing Address - Phone:346-396-5673
Mailing Address - Fax:346-396-5674
Practice Address - Street 1:1213 HERMANN DR STE 845
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7027
Practice Address - Country:US
Practice Address - Phone:346-396-5673
Practice Address - Fax:346-396-5674
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93551223E0200X
TX308051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics