MEDICARE: DR. ETHEL A. ESIANOR-MITCHUAL DDS

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	1223G0001X	General Practice Dentistry	DS029950L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000183384	OTHER	PA	DENTISTRY

General Provider Information

NPI Number	:	1467549469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHEL A. ESIANOR-MITCHUAL DDS

Provider Business Mailing Address
First Line	:	822 MARIETTA AVE STE 21
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3239
Country	:	US
Telephone Number	:	717-393-5055
Fax Number	:	717-393-5676

Provider Business Practice Location Address
First Line	:	822 MARIETTA AVE STE 21
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3239
Country	:	US
Telephone Number	:	717-393-5055
Fax Number	:	717-393-5676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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