Provider Demographics
NPI:1871698043
Name:MITCHELL, MATTHEW C (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:211 HIGH POINT CT
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5528
Mailing Address - Country:US
Mailing Address - Phone:502-538-2400
Mailing Address - Fax:502-538-2403
Practice Address - Street 1:211 HIGH POINT CT
Practice Address - Street 2:SUITE 500
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-5528
Practice Address - Country:US
Practice Address - Phone:502-538-2400
Practice Address - Fax:502-538-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY8061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100071020Medicaid