Provider Demographics
NPI:1992250260
Name:MOMANY, CHELSEA CROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:CROSS
Last Name:MOMANY
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 1:908 S CUSHMAN AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3664
Mailing Address - Country:US
Mailing Address - Phone:509-435-2684
Mailing Address - Fax:
Practice Address - Street 1:2921 5TH AVE NE
Practice Address - Street 2:STE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7044
Practice Address - Country:US
Practice Address - Phone:253-200-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60670481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist