Provider Demographics
NPI:1831881952
Name:MITCHELL, NATHANIEL ALLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ALLAN
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 1:956 S PHEASANT VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3300
Mailing Address - Country:US
Mailing Address - Phone:971-284-5250
Mailing Address - Fax:
Practice Address - Street 1:820 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2228
Practice Address - Country:US
Practice Address - Phone:801-771-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14009214-99231223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice