MEDICARE: DR. JACQUELINE BUTLER-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	07913	TN

General Provider Information

NPI Number	:	1841289535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE BUTLER-MITCHELL DDS

Provider Business Mailing Address
First Line	:	301 WOLVERINE TRL
Second Line	:	SUITE 203
City	:	SMYRNA
State	:	TN
Zip	:	37167-5656
Country	:	US
Telephone Number	:	615-220-5533
Fax Number	:	615-220-5376

Provider Business Practice Location Address
First Line	:	301 WOLVERINE TRL
Second Line	:	SUITE 203
City	:	SMYRNA
State	:	TN
Zip	:	37167-5656
Country	:	US
Telephone Number	:	615-220-5533
Fax Number	:	615-220-5376

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/20/2008

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