Provider Demographics
NPI:1053959585
Name:ROSS MITCHELL DMD
Entity type:Organization
Organization Name:ROSS MITCHELL DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:PATON
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-924-1190
Mailing Address - Street 1:1030 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3416
Mailing Address - Country:US
Mailing Address - Phone:541-924-1190
Mailing Address - Fax:541-812-0332
Practice Address - Street 1:1030 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3416
Practice Address - Country:US
Practice Address - Phone:541-924-1190
Practice Address - Fax:541-812-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSS MITCHELL DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty