Active NPI
Glen B Mitchell, DDS
- Endodontics
- Boca Raton, FL
National Provider Identifier
1376648055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN12931
- Practice address
- 7000 W Palmetto Park Rd
Suite 504
Boca Raton, FL 33433-3424 - Phone
- (561) 368-3636
- Fax
- (561) 368-8997
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN12931 | FL | Primary |
Addresses
Primary practice location
7000 W Palmetto Park Rd
Suite 504
Boca Raton, FL 33433-3424
Mailing address
7000 W Palmetto Park Rd
Suite 504
Boca Raton, FL 33433-3424
Phone (561) 368-3636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160222002515 | FL | Order and Referring Only - Other (Physician) | 9335444884 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376648055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7000 W PALMETTO PARK RD",
"address_2": "SUITE 504",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334333424",
"telephone_number": "561-368-3636",
"fax_number": "561-368-8997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000 W PALMETTO PARK RD",
"address_2": "SUITE 504",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334333424",
"telephone_number": "561-368-3636",
"fax_number": "561-368-8997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "GLEN",
"middle_name": "B",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN12931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.