# DR. KENNETH COOPER MITCHELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1801024690
- **Gender:** Man
- **Credential:** D.D.S., FAGD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2405 | MT | Yes |
| 1223G0001X | General Practice Dentistry | D4228 | ID | — |

## Other

- **Enumeration date:** 06/30/2009
- **Last updated:** 03/31/2020