Healthcare Provider Details

I. General information

NPI: 1093209181
Provider Name (Legal Business Name): JENNIFER MARGARET MITCHELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 HIGHWAY 14 E
ROCHESTER MN
55904-5101
US

IV. Provider business mailing address

433 BOULDER RD SE
ROCHESTER MN
55904-7001
US

V. Phone/Fax

Practice location:
  • Phone: 507-258-7934
  • Fax: 507-322-0041
Mailing address:
  • Phone: 810-348-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09542
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14153
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: