Individual
DR. JERRY WAYNE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
620 FIRST AVE N, KETCHUM, ID 83340-0000
(208) 720-7368
Mailing address
PO BOX 4378, 620 FIRST AVE N, KETCHUM, ID 83340-0000
(208) 720-7368
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00005295
WA
Other
Enumeration date
10/17/2006
Last updated
12/13/2012
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