Provider Demographics
NPI:1619648227
Name:MESIMER, MISTY LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LYNN
Last Name:MESIMER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LITTLE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-3139
Mailing Address - Country:US
Mailing Address - Phone:540-379-2732
Mailing Address - Fax:
Practice Address - Street 1:213 GERMANNA HWY.
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508
Practice Address - Country:US
Practice Address - Phone:540-423-9823
Practice Address - Fax:540-423-9827
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402004227124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist