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General NPI Number Information
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NPI Number | 1346780582
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Entity Type | Organization
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Legal Business Name | VIRGINIA M MITCHELL DDS P C
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 14 MARKET ST
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City | CENTEREACH
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State | NY
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Zip | 11720-2246
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Country | US
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Telephone | 631-588-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MARKET ST
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City | CENTEREACH
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State | NY
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Zip | 11720-2246
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Country | US
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Telephone | 631-588-8890
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. VIRGINIA M. MITCHELL
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Credential | D.D.S.
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Telephone | 631-588-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 040954
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License Number State | NY
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