Healthcare Provider Details

I. General information

NPI: 1720145659
Provider Name (Legal Business Name): STEPHEN C. MITCHELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

1530 3RD AVE S SDB 89
BIRMINGHAM AL
35294-0002
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-1136
  • Fax: 205-934-7013
Mailing address:
  • Phone: 205-934-1136
  • Fax: 205-934-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4724
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: