Healthcare Provider Details

I. General information

NPI: 1740901198
Provider Name (Legal Business Name): MITCHELL KESTNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 WHITESBURG DR SE
HUNTSVILLE AL
35801-3829
US

IV. Provider business mailing address

2326 BRANDON ST SW
HUNTSVILLE AL
35801-3801
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-3735
  • Fax:
Mailing address:
  • Phone: 256-694-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-0007108-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: