Provider Demographics
NPI:1730521063
Name:MITCHELL, COURTNEY IV (DDS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:MITCHELL
Suffix:IV
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 1:2500 N. HERRITAGE ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501
Mailing Address - Country:US
Mailing Address - Phone:252-522-4313
Mailing Address - Fax:252-522-5777
Practice Address - Street 1:2500 N HERRITAGE ST.
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501
Practice Address - Country:US
Practice Address - Phone:252-522-4313
Practice Address - Fax:252-522-5777
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice