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Individual
MRS. MISTY M SHORT CLINE
Active
Individual
MRS. MISTY M SHORT CLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401412415
VA
1223G0001X
General Practice Dentistry
3816
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366600850
—
VA
05
—
3810012047
—
WV
Enumeration date
05/30/2008
Last updated
01/21/2021
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