MEDICARE: DR. BARRY EDWARD MITCHEL 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	041498	NY

General Provider Information

NPI Number	:	1861472607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY EDWARD MITCHEL DDS

Provider Business Mailing Address
First Line	:	982 MARCEL RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-5039
Country	:	US
Telephone Number	:	516-868-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	8410 153RD AVE
Second Line	:	SUITE LM
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1943
Country	:	US
Telephone Number	:	718-848-4777
Fax Number	:	718-835-1881

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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