Provider Demographics
NPI:1174484265
Name:MENSAH, PRICILLA
Entity type:Individual
Prefix:
First Name:PRICILLA
Middle Name:
Last Name:MENSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9539
Mailing Address - Country:US
Mailing Address - Phone:984-269-9955
Mailing Address - Fax:
Practice Address - Street 1:3565 PA-611
Practice Address - Street 2:SUITE 300
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321
Practice Address - Country:US
Practice Address - Phone:570-629-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH075708124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist