1346338514 NPI number — DR. ROBERT LEVIS MITCHELL III DDS

Table of content: DR. ROBERT LEVIS MITCHELL III DDS (NPI 1346338514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346338514 NPI number — DR. ROBERT LEVIS MITCHELL III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
ROBERT
Provider Middle Name:
LEVIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
BOB
Provider Other Middle Name:
LEVIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346338514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3508 FAR WEST BLVD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-346-4454
Provider Business Mailing Address Fax Number:
512-346-4595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3508 FAR WEST BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-346-4454
Provider Business Practice Location Address Fax Number:
512-346-4595
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  11115 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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