Healthcare Provider Details

I. General information

NPI: 1720077449
Provider Name (Legal Business Name): ALVAN E MITCHELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 S HARRISON ST SUITTE 1N
EAST ORANGE NJ
07018-1218
US

IV. Provider business mailing address

377 S HARRISON ST SUITTE 1N
EAST ORANGE NJ
07018-1218
US

V. Phone/Fax

Practice location:
  • Phone: 973-673-8688
  • Fax: 973-673-1119
Mailing address:
  • Phone: 973-673-8688
  • Fax: 973-673-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01805700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: