Individual
KEVIN WAYNE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
851 WEST GRANT, DEXTER, MO 63841
(573) 624-8005
(573) 624-3885
Mailing address
PO BOX 488, 851 WEST GRANT, DEXTER, MO 63841
(573) 624-8005
(573) 624-3885
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15266
MO
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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