Provider Demographics
NPI:1205304904
Name:HIMES, MARISSA (RDH)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HIMES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ANN
Other - Last Name:ATHERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:814-223-9906
Mailing Address - Fax:814-223-9912
Practice Address - Street 1:30 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-3800
Practice Address - Country:US
Practice Address - Phone:814-223-9906
Practice Address - Fax:814-223-9912
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH072025124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035705460001Medicaid