Individual
DR. JOHN L. MIXER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901011411
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901011411
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4193792
—
MI
05
—
4204519
—
MI
01
—
97 0 F1 1036 0
BLUE CROSS MEDICAL
MI
01
—
D800376
BLUE CROSS DENTAL
MI
Enumeration date
03/14/2006
Last updated
01/26/2010
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