Provider Demographics
NPI:1770711384
Name:MITCHELL, ELIZABETH GRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GRAHAM
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:795 RIDGE LAKE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9475
Mailing Address - Country:US
Mailing Address - Phone:901-756-1151
Mailing Address - Fax:901-756-1575
Practice Address - Street 1:795 RIDGE LAKE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9475
Practice Address - Country:US
Practice Address - Phone:901-756-1151
Practice Address - Fax:901-756-1575
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90001223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice