Provider Demographics
NPI:1255110888
Name:SLUYTER, MISTY D (RDH)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:SLUYTER
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 1:3313 JOHN MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1378
Mailing Address - Country:US
Mailing Address - Phone:703-593-7973
Mailing Address - Fax:
Practice Address - Street 1:3313 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1378
Practice Address - Country:US
Practice Address - Phone:703-593-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203948124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist