Provider Demographics
NPI:1801421268
Name:MITCHELL, CASSANDRA LISTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LISTON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CARNES CROSSING BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-0407
Mailing Address - Country:US
Mailing Address - Phone:843-761-7380
Mailing Address - Fax:
Practice Address - Street 1:501 CARNES CROSSING BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0407
Practice Address - Country:US
Practice Address - Phone:843-761-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist