=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447610738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MITCHELL DENTAL CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2016
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 PINEVIEW DR
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-6039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-992-1285
-----------------------------------------------------
Fax | 601-992-4340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 PINEVIEW DR
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-6039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-285-6828
-----------------------------------------------------
Fax | 662-285-6896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN D MITCHELL JR.
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 662-803-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2985-91
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------