John Herman Mitchell Jr., DDS
Individual provider Active NPI General Practice Dentistry · Simmesport, LA
NPI 1790798601 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790798601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3440 (LA)
- Practice address
- 352 Mission Drive
Simmesport, LA 71369 - Phone
- (318) 941-2071
- Fax
- (318) 941-2629
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3440 | LA | MD | School Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3440 | LA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1834408 | Medicaid | LA |
Other providers in Simmesport, LA
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- Louisiana Health Care Practitioners LLC
- Traverick Raydrakeyon Mason
- MTZ Rising Suns Transportation LLC
- Newell E. Gauthier Jr. MD
- Raymond Maurice Njalle
- Peace Management Inc
- Peace Management Inc
All providers in Simmesport, LA · General Practice Dentistry in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.