Provider Demographics
NPI:1811036247
Name:DENT, TYESHA DAWN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TYESHA
Middle Name:DAWN MARIE
Last Name:DENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TYESHA
Other - Middle Name:DAWN MARIE
Other - Last Name:SITSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6857 HWY. 21
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533
Mailing Address - Country:US
Mailing Address - Phone:701-584-3246
Mailing Address - Fax:701-584-3011
Practice Address - Street 1:302 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533
Practice Address - Country:US
Practice Address - Phone:701-584-3010
Practice Address - Fax:701-584-3011
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11228Medicaid
ND28537OtherBLUE CROSS BLUE SHIELD
ND28537OtherBLUE CROSS BLUE SHIELD