Individual
DARREL WAITE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2331 FARGO ST, KLAMATH FALLS, OR 97603-6758
(541) 884-6477
(541) 884-6499
Mailing address
2331 FARGO ST, KLAMATH FALLS, OR 97603-6758
(541) 884-6477
(541) 884-6499
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6665
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082011
OMAP
OR
Enumeration date
10/19/2006
Last updated
07/08/2007
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