Cda Lake Winola Llc | |
1220 Pa-307 Factoryville PA 18419 | |
(570) 378-3305 | |
(570) 378-3430 |
Full Name | Cda Lake Winola Llc |
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Speciality | Dentist - General Practice |
Location | 1220 Pa-307, Factoryville, Pennsylvania |
Authorized Official Name and Position | Jason J Hanyon (OWNER) |
Authorized Official Contact | 5703783305 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Cda Lake Winola Llc 1220 Pa-307 Factoryville PA 18419 Ph: (570) 378-3305 | Cda Lake Winola Llc 1220 Pa-307 Factoryville PA 18419 Ph: (570) 378-3305 |
NPI Number | 1104491653 |
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Provider Enumeration Date | 05/26/2021 |
Last Update Date | 05/26/2021 |
Identifier | Type | State | Issuer |
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1104491653 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |