Healthcare Provider Details

I. General information

NPI: 1932148152
Provider Name (Legal Business Name): MITCHELL H. DAVICH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MADISON AVE SUITE A02
MORRISTOWN NJ
07960-6092
US

IV. Provider business mailing address

95 MADISON AVE SUITE A02
MORRISTOWN NJ
07960-6092
US

V. Phone/Fax

Practice location:
  • Phone: 973-898-0100
  • Fax: 973-267-2290
Mailing address:
  • Phone: 973-898-0100
  • Fax: 973-267-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI01228100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: