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General NPI Number Information
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NPI Number | 1659576668
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Entity Type | Individual
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Provider Name | SARAH MORGAN PETERSON MITCHELL D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 13206 W HIGHWAY 42 SUITE 103
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City | PROSPECT
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State | KY
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Zip | 40059-8221
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Country | US
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Telephone | 502-228-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 13206 W HIGHWAY 42 SUITE 103
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City | PROSPECT
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State | KY
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Zip | 40059-8221
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Country | US
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Telephone | 502-228-9494
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Fax |
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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 | 8494
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 841
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License Number State | KY
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