MEDICARE: KENDALL A MITCHELL DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9769	NC

General Provider Information

NPI Number	:	1326591256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDALL A MITCHELL DDS PLLC

Provider Business Mailing Address
First Line	:	400 GLENWOOD AVE
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-3870
Country	:	US
Telephone Number	:	252-523-4927
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 GLENWOOD AVE
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-3870
Country	:	US
Telephone Number	:	252-523-4927
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KENDALL A MITCHELL
Credential	:
Telephone Number	:	252-523-4927

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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