Organization
DEMAREE MITCHELL FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN WAYNE MITCHELL (DENTIST)
(573) 624-8005
Entity
Organization
Contact information
Practice address
851 W GRANT ST, DEXTER, MO 63841-2430
(573) 624-8005
Mailing address
851 W GRANT ST, P.O. BOX 488, DEXTER, MO 63841-2430
(573) 624-8005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15266
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403047012
—
MO
Enumeration date
01/14/2010
Last updated
01/14/2010
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