Healthcare Provider Details

I. General information

NPI: 1578093233
Provider Name (Legal Business Name): HANNAH ELISABETH MIXTER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 COMMERCIAL WAY
SANTA CRUZ CA
95065-1819
US

IV. Provider business mailing address

9560 SW ARDENWOOD ST
PORTLAND OR
97225-4907
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-5409
  • Fax:
Mailing address:
  • Phone: 603-686-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number101419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: