Healthcare Provider Details

I. General information

NPI: 1427146489
Provider Name (Legal Business Name): MITCHELL ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 HIGHWAY 280 SUITE 118
BIRMINGHAM AL
35242-6585
US

IV. Provider business mailing address

5511 HIGHWAY 280 SUITE 118
BIRMINGHAM AL
35242-6585
US

V. Phone/Fax

Practice location:
  • Phone: 205-980-9000
  • Fax: 205-980-1399
Mailing address:
  • Phone: 205-980-9000
  • Fax: 205-980-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number17041
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number03787
License Number StateAL

VIII. Authorized Official

Name: DR. PHILLIP ANTHONY MITCHELL
Title or Position: OWNER
Credential: DMD, MD
Phone: 205-980-9000