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General NPI Number Information
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NPI Number | 1942328745
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Entity Type | Organization
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Legal Business Name | DONNA CLARK-HAGY D.D.S. AND ANTHONY J. MITCHELL D.D.S.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2810 NACOGDOCHES RD
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5827
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Country | US
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Telephone | 210-828-9644
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Fax | 210-828-9646
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Provider Business Mailing Address
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Address Line | 2810 NACOGDOCHES RD
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5827
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Country | US
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Telephone | 210-828-9644
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Fax | 210-828-9646
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY JOHN MITCHELL
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Credential | D.D.S.
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Telephone | 210-828-9644
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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 | 14101
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License Number State | TX
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