Individual
MR. SAMUEL EDWARD MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
MISSION ROAD, FORT HALL, ID 83203
(208) 238-5446
(208) 238-5463
Mailing address
1222 FREEMAN LANE, APT 67, POCATELLO, ID 83201
(208) 478-6650
(208) 238-5463
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052435
NY
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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