Healthcare Provider Details

I. General information

NPI: 1285576629
Provider Name (Legal Business Name): MITCHELL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14895 E 14TH ST STE 420
SAN LEANDRO CA
94578-2928
US

IV. Provider business mailing address

4400 KELLER AVE STE 140
OAKLAND CA
94605-4233
US

V. Phone/Fax

Practice location:
  • Phone: 510-846-5366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERI MITCHELL
Title or Position: PRESIDENT
Credential: DDS
Phone: 415-966-2203