Provider Demographics
NPI:1013375476
Name:MOMIN, MONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 W RIVER RD
Mailing Address - Street 2:APT 7205
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1464
Mailing Address - Country:US
Mailing Address - Phone:512-779-8205
Mailing Address - Fax:
Practice Address - Street 1:1925 W RIVER RD
Practice Address - Street 2:APT 7205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1464
Practice Address - Country:US
Practice Address - Phone:512-779-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program