Healthcare Provider Details

I. General information

NPI: 1407963986
Provider Name (Legal Business Name): CHRISTOPHER SCOTT MITCHELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CRYSTAL PLACE
LAGRANGE KY
40031
US

IV. Provider business mailing address

604 CRYSTAL PLACE
LAGRANGE KY
40031
US

V. Phone/Fax

Practice location:
  • Phone: 502-225-9400
  • Fax: 502-225-9404
Mailing address:
  • Phone: 502-225-9400
  • Fax: 502-225-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7883
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: