Bradley W Mitchell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19015801 Issued in IL

Practice address

413 W 3Rd St
Waterloo, IL 62298-1358

Phone

(618) 939-6128

Fax

(618) 939-6128

NPI assigned

Aug 28, 2008

Last updated

Aug 28, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1720236128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 W 3RD ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981358",
            "telephone_number": "618-939-6128",
            "fax_number": "618-939-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 W 3RD ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981358",
            "telephone_number": "618-939-6128",
            "fax_number": "618-939-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BRADLEY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19015801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Michael Meredith, PAC
• Elizabeth Mifflin, MS, CCC-SLP
• Ivan Milicevic, LCPC
• Colleen Marie Miller, D.C.
• Eric James Milligan
• Michele D Moldrem, MHNP
• Daniel Moll, RSA
• Monroe County (Oak Hill)
• Monroe County (Magnolia Terrace)
• Monroe County (Oak Hill)

• General Practice Dentistry in Waterloo, IL
• Providers in Waterloo, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.