IndividualActive
Bradley Mitchell, DMD
NPI 1720236128 · General Practice Dentistry · Waterloo, IL
Provider details
- NPI number
- 1720236128
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 19015801 (IL)
Specialties & taxonomies
Dental Providers
Practice location
413 W 3rd St
Waterloo, IL 62298-1358
Phone: (618) 939-6128
Fax: (618) 939-6128
Approximate (ZIP-level) locationGet directions
Mailing address
413 W 3rd St
Waterloo, IL 62298-1358
Registry dates
- Enumerated
- 2008-08-28
- Last updated
- 2008-08-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.