Active NPI
John Herman Mitchell Jr., DDS
- General Practice Dentistry
- Simmesport, LA
National Provider Identifier
1790798601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3440
- Practice address
- 352 Mission Drive
Simmesport, LA 71369 - Phone
- (318) 941-2071
- Fax
- (318) 941-2629
- NPI assigned
- Aug 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 3440 | LA | Primary |
Addresses
Primary practice location
352 Mission Drive
Simmesport, LA 71369
Mailing address
PO Box 130
352 Mission Drive
Simmesport, LA 71369
Phone (318) 941-2071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1834408 | Medicaid | LA |
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 |
|---|---|---|---|
| 3440 | LA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790798601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 130",
"address_2": "352 MISSION DRIVE",
"city": "SIMMESPORT",
"state": "LA",
"postal_code": "71369",
"telephone_number": "318-941-2071",
"fax_number": "318-941-2629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "352 MISSION DRIVE",
"city": "SIMMESPORT",
"state": "LA",
"postal_code": "71369",
"telephone_number": "318-941-2071",
"fax_number": "318-941-2629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "JOHN",
"middle_name": "HERMAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "3440",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1834408",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Simmesport, LA
- KD Health & Wellness Center LLC
- Shelby Lambert, RN, BSN, LC(CBI)
- Living Not Existing Wellness Center LLC
- Louisiana Health Care Practitioners LLC (Simmesport Family Clinic)
- Traverick Raydrakeyon Mason
- MTZ Rising Suns Transportation LLC (MTZ Rising Suns Transportation)
- Newell E. Gauthier Jr. MD
- Raymond Maurice Njalle, P.T
- Peace Management Inc (Lacours Pharmacy)
- Peace Management Inc (LaCour's Pharmacy Retail)
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.