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General NPI Number Information
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NPI Number | 1215927181
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Entity Type | Individual
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Provider Name | MITCHELL JAY HENRY M.D., D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 2222 S 16TH ST SUITE 300
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City | LINCOLN
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State | NE
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Zip | 68502
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Country | US
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Telephone | 402-435-0044
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Fax | 402-435-7010
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Provider Business Mailing Address
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Address Line | 2222 S 16TH ST STE 300
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City | LINCOLN
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State | NE
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Zip | 68502
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Country | US
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Telephone | 402-435-0044
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Fax | 402-435-7010
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 18887
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5504
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License Number State | NE
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