Healthcare Provider Details

I. General information

NPI: 1811683600
Provider Name (Legal Business Name): VICTORIA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 LIVE OAK ST
COMMERCE TX
75428-2545
US

IV. Provider business mailing address

3302 GASTON AVE
DALLAS TX
75246-2013
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-7833
  • Fax:
Mailing address:
  • Phone: 214-828-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: