Mitchell Douglas Duckworth, DDS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

Stony Brook University Hospital Dept of
Stony Brook, NY 11794-8711

Phone

(631) 444-2557

Fax

(631) 444-6013

NPI assigned

May 24, 2012

Last updated

May 19, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Family Surgical Suite

  • Ambulatory Surgical Clinic/Center
  • West Jordan, UT
  • NPI 1508040221
  Medicare reassignment NPD
• Care Anesthesia

  • Dental Anesthesiology
  • Holladay, UT
  • NPI 1134095151
  NPD Authorized official
• Care Anesthesia

  dba Summit Anesthesia

  • Dental Anesthesiology
  • Salt Lake City, UT
  • NPI 1972248557
  NPD Authorized official
• Summit Anesthesia, PLLC

  • Dental Anesthesiology
  • Holladay, UT
  • NPI 1427840297
  NPD Authorized official
• Family Surgical Suite

  • Ambulatory Surgical Clinic/Center
  • Murray, UT
  • NPI 1083861165
  NPD
• Family Surgical Suite

  • Anesthesiology Physician
  • Murray, UT
  • NPI 1811146384
  NPD

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1649530601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5136 S COTTONWOOD LN",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841177102",
            "telephone_number": "801-718-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK UNIVERSITY HOSPITAL DEPT OF",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948711",
            "telephone_number": "631-444-2557",
            "fax_number": "631-444-6013"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5136 S Cottonwood Ln",
            "address_purpose": "LOCATION",
            "city": "Holladay",
            "state": "UT",
            "postal_code": "841177102",
            "country_code": "US",
            "telephone_number": "801-718-6395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUCKWORTH",
        "first_name": "MITCHELL",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-24",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "UT",
            "license": "8926334-9924",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Drago, DO
• Myron Drazen, PHD
• Allison Dreier, MD
• Stuart Loren Drew
• Duane Reade (Duane Reade #14257)
• Dennis K Duffy, P.A.
• Erin I Duffy, MD
• Shradha Duggal
• Sarah Duggan
• Kevin Duh

• Student in an Organized Health Care Education/Training Program in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; 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.

Verify at the official NPI Registry.