Individual
MR. JEROME MITHCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 W FRONT ST, BLOOMINGTON, IL 61701-5048
(309) 888-5533
(309) 888-5896
Mailing address
PO BOX 6321, BLOOMINGTON, IL 61702-6321
(309) 310-3273
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019017536
IL
Other
Enumeration date
08/27/2008
Last updated
08/27/2008
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