Provider Demographics
NPI:1306502323
Name:MISTISHEN, EMILY (RDH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MISTISHEN
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 1:2525 SIMON DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9166
Mailing Address - Country:US
Mailing Address - Phone:570-789-4111
Mailing Address - Fax:
Practice Address - Street 1:2525 SIMON DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19608-9166
Practice Address - Country:US
Practice Address - Phone:570-789-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH073553124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist