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General NPI Number Information
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NPI Number | 1760739171
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Entity Type | Individual
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Provider Name | MITCHELL JAMES LEE OLIVER DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 450 GIBNER RD
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City | CARLISLE
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State | PA
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Zip | 17013-5090
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Country | US
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Telephone | 719-629-7714
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Fax |
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Provider Business Mailing Address
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Address Line | 450 GIBNER RD
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City | CARLISLE
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State | PA
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Zip | 17013-5090
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Country | US
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Telephone | 717-245-4541
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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 | 8371342-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8371342-9922
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License Number State | UT
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