Individual provider Active NPI

Bruce Paul Mitchell, D.M.D.

  • General Practice Dentistry
  • Medford, OR
National Provider Identifier
1629060884
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7767 Issued in OR
Practice address
1762 E McAndrews Rd
Medford, OR 97504-5577
Phone
(541) 773-3959
Fax
(541) 773-1186
NPI assigned
Aug 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7767 OR Primary

Addresses

Primary practice location

1762 E McAndrews Rd
Medford, OR 97504-5577

Mailing address

1762 E McAndrews Rd
Medford, OR 97504-5577
Phone (541) 773-3959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160412000185 OR Order and Referring Only - DentistPractitioner - Dentist 5294033080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7767ORMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1629060884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1762 E MCANDREWS RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045577",
            "telephone_number": "541-773-3959",
            "fax_number": "541-773-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1762 E MCANDREWS RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045577",
            "telephone_number": "541-773-3959",
            "fax_number": "541-773-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BRUCE",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "7767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.