Provider Demographics
NPI:1942497177
Name:MOMEN, SEEMA
Entity Type:Individual
Prefix:DR
First Name:SEEMA
Middle Name:
Last Name:MOMEN
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 1:1131 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3518
Mailing Address - Country:US
Mailing Address - Phone:610-383-3888
Mailing Address - Fax:610-383-4688
Practice Address - Street 1:1131 OLIVE ST
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3518
Practice Address - Country:US
Practice Address - Phone:610-383-3888
Practice Address - Fax:610-383-4688
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029404L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019382290001Medicaid