Individual provider · Type 1 NPI

Mitchell Douglas Duckworth, DDS

Student in an Organized Health Care Education/Training Program · Stony Brook, NY

NPI number 1649530601 Active

Practice location

Stony Brook University Hospital Dept Of
Stony Brook, NY 11794-8711

Call (631) 444-2557 Map

Fax (631) 444-6013

Mailing address

5136 S Cottonwood Ln
Holladay, UT 84117-7102

Other practice locations

  • 5136 S Cottonwood Ln, Holladay, UT 84117-7102 · (801) 718-6395

Specialties and licenses

TaxonomyCodeLicense
Dental Anesthesiology 1223D0004X8926334-9924 (UT)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1649530601

Mitchell Douglas Duckworth, DDS's National Provider Identifier is 1649530601, issued on May 24, 2012. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Stony Brook, NY. The record was last updated on May 19, 2025.