Provider Demographics
NPI:1760282925
Name:MOMMSEN, MARYA (RDH)
Entity type:Individual
Prefix:
First Name:MARYA
Middle Name:
Last Name:MOMMSEN
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15437-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 NEW MEADOW RUN DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:PA
Practice Address - Zip Code:15437-1391
Practice Address - Country:US
Practice Address - Phone:724-749-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH073449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist