Provider Demographics
NPI:1033598131
Name:MISTY DENTAL PLLC
Entity Type:Organization
Organization Name:MISTY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:KENDILL
Authorized Official - Last Name:EILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-396-6100
Mailing Address - Street 1:419 34TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1411
Mailing Address - Country:US
Mailing Address - Phone:202-396-6100
Mailing Address - Fax:202-388-0987
Practice Address - Street 1:419 34TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1411
Practice Address - Country:US
Practice Address - Phone:202-396-6100
Practice Address - Fax:202-388-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty