# MRS. MISTY M SHORT CLINE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1366600850
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401412415 | VA | Yes |
| 1223G0001X | General Practice Dentistry | 3816 | WV | — |

## Other

- **Enumeration date:** 05/30/2008
- **Last updated:** 01/21/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1366600850 | — | VA |
| 05 | — | 3810012047 | — | WV |