NPIMap

Individual provider Active NPI

Brian Mitchell, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Kingston, PA
National Provider Identifier
1619407608
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DS042996 Issued in PA
Practice address
550 Third Avenue Suite 1
Kingston, PA 18704-5806
Phone
(570) 288-9070
Fax
(570) 288-4201
NPI assigned
Jun 13, 2017
Last updated
Jul 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS042996 PA Primary

Addresses

Primary practice location

550 Third Avenue Suite 1
Kingston, PA 18704-5806

Mailing address

550 Third Avenue Suite 1
Kingston, PA 18704-5806
Phone (570) 288-9070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210709001499 PA Practitioner - Oral Surgery 1254603160 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Marquette University School of Dentistry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wyoming Valley Oral Surgery PLLCGroup PAC ID 4981053048, 2 clinicians

Practice addresses (Care Compare)

550 3Rd Ave
Suite 1
Kingston, PA 18704-5806
Phone (570) 288-9070

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS042996PAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Callahan and Bergey Associates P.C. Oral and Maxillofacial Surgery CurrentSince Aug 2, 2021 Accepting new patients
Wyoming Valley Oral Surgery PLLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

550 3rd Ave
Ste 1
Kingston, PA 18704
Phone (570) 288-9070

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1619407608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 THIRD AVENUE SUITE 1",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045806",
            "telephone_number": "570-288-9070",
            "fax_number": "570-288-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 THIRD AVENUE SUITE 1",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045806",
            "telephone_number": "570-288-9070",
            "fax_number": "570-288-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BRIAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS042996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

Verify at the official NPI Registry.