Provider Demographics
NPI:1730258583
Name:AVENT, MITCHELL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:AVENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 MCMANUS BLVD
Mailing Address - Street 2:BUILDING #1 SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602
Mailing Address - Country:US
Mailing Address - Phone:757-874-0660
Mailing Address - Fax:757-874-0698
Practice Address - Street 1:12725 MCMANUS BLVD
Practice Address - Street 2:BUILDING #1 SUITE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-874-0660
Practice Address - Fax:757-874-0698
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4981OtherDELTA DENTAL
878129OtherUNITED CONCORDIA
091512OtherBCBS
VA8212775Medicaid