Individual
DR. BRADLEY W MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
413 W 3RD ST, WATERLOO, IL 62298-1358
(618) 939-6128
(618) 939-6128
Mailing address
413 W 3RD ST, WATERLOO, IL 62298-1358
(618) 939-6128
(618) 939-6128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19015801
IL
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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