| Pocono Pines Dental Llc | |
|
395 Route 940 Suite 102 Blakeslee PA 18610 | |
| (570) 646-7811 | |
| Not Available |
| Full Name | Pocono Pines Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 395 Route 940, Blakeslee, Pennsylvania |
| Authorized Official Name and Position | John Mann (MEMBER) |
| Authorized Official Contact | 5706467811 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pocono Pines Dental Llc Po Box 1005 395 Route 940 Suite 102 Blakeslee PA 18610 Ph: (570) 646-7811 | Pocono Pines Dental Llc 395 Route 940 Suite 102 Blakeslee PA 18610 Ph: (570) 646-7811 |
| NPI Number | 1750789087 |
|---|---|
| Provider Enumeration Date | 12/19/2014 |
| Last Update Date | 12/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750789087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS03529 (* (Not Available)) | Primary |
| 122300000X | Dentist | DS035165 (* (Not Available)) | Secondary |