MEDICARE: MISTY D SLUYTER RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	0402203948	VA

General Provider Information

NPI Number	:	1255110888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY D SLUYTER RDH

Provider Business Mailing Address
First Line	:	3313 JOHN MARSHALL DR
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1378
Country	:	US
Telephone Number	:	703-593-7973
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 JOHN MARSHALL DR
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1378
Country	:	US
Telephone Number	:	703-593-7973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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