MEDICARE: POCONO ORAL SURGERY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS035287	PA

General Provider Information

NPI Number	:	1194963900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO ORAL SURGERY PC

Provider Business Mailing Address
First Line	:	1095 TEXAS PALMYRA HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-7687
Country	:	US
Telephone Number	:	570-253-4000
Fax Number	:	570-253-8977

Provider Business Practice Location Address
First Line	:	1095 TEXAS PALMYRA HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-7687
Country	:	US
Telephone Number	:	570-253-4000
Fax Number	:	570-253-8977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL SCOTT MONTO
Credential	:	DMD,MD
Telephone Number	:	570-253-4000

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/02/2009

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Directions to “POCONO ORAL SURGERY PC ” Practice Location

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