Provider Demographics
NPI:1467406504
Name:DENT, MISHA (PA)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:DENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 1ST AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-535-7111
Mailing Address - Fax:
Practice Address - Street 1:4540 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1936
Practice Address - Country:US
Practice Address - Phone:045-257-1113
Practice Address - Fax:304-736-1589
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01042363A00000X
WV1042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001807955OtherBLUE CROSS BLUE SHIELD
WV3001166OtherWORKERS COMPENSATION
WVQ00673Medicare UPIN
WV001807955OtherBLUE CROSS BLUE SHIELD
WVP00372236Medicare PIN