Healthcare Provider Details

I. General information

NPI: 1447197645
Provider Name (Legal Business Name): JENNIFER MITCHELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27690 VAN DYKE AVE
WARREN MI
48093-2842
US

IV. Provider business mailing address

48862 POINT LAKEVIEW DR
CHESTERFIELD MI
48047-3417
US

V. Phone/Fax

Practice location:
  • Phone: 586-465-8070
  • Fax:
Mailing address:
  • Phone: 586-801-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902012736
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: