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General NPI Number Information
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NPI Number | 1083094569
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Entity Type | Individual
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Provider Name | MITCHELL VANHOOSE
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Gender | Male
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 716 ADAIR AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2836
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Country | US
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Telephone | 740-891-9000
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Fax | 740-891-9001
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Provider Business Mailing Address
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Address Line | 859 N MAIN ST
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City | MALTA
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State | OH
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Zip | 43758-9007
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Country | US
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Telephone | 740-962-6111
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Fax | 740-962-2182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30024515
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License Number State | OH
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