Provider Demographics
NPI:1730365230
Name:MITCHELL, CANDACE EMILE (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:EMILE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1129
Mailing Address - Country:US
Mailing Address - Phone:202-462-8752
Mailing Address - Fax:202-667-0355
Practice Address - Street 1:121 S ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1129
Practice Address - Country:US
Practice Address - Phone:202-462-8752
Practice Address - Fax:202-667-0355
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN39061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0168791 00Medicaid