Active NPI
John P. Mitchell, DMD
- General Practice Dentistry
- Dracut, MA
National Provider Identifier
1609801083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12900
- Practice address
- 635 Methuen St
Dracut, MA 01826-5220 - Phone
- (978) 458-8845
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12900 | MA | Primary |
Addresses
Primary practice location
635 Methuen St
Dracut, MA 01826-5220
Mailing address
635 Methuen St
Dracut, MA 01826-5220
Phone (978) 458-8845
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0246123 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12900 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609801083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 METHUEN ST",
"city": "DRACUT",
"state": "MA",
"postal_code": "018265220",
"telephone_number": "978-458-8845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 METHUEN ST",
"city": "DRACUT",
"state": "MA",
"postal_code": "018265220",
"telephone_number": "978-458-8845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "JOHN",
"middle_name": "P.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "12900",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0246123",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dracut, MA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.