MEDICARE: DR. ROBERT BRUCE MITCHELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10618	TX

General Provider Information

NPI Number	:	1760499032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BRUCE MITCHELL DDS

Provider Business Mailing Address
First Line	:	5438 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4506
Country	:	US
Telephone Number	:	972-233-1311
Fax Number	:	972-701-0322

Provider Business Practice Location Address
First Line	:	5438 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4506
Country	:	US
Telephone Number	:	972-233-1311
Fax Number	:	972-701-0322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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