Healthcare Provider Details

I. General information

NPI: 1568824498
Provider Name (Legal Business Name): PO DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 MANHEIM PIKE
LANCASTER PA
17601-3027
US

IV. Provider business mailing address

1661 MANHEIM PIKE
LANCASTER PA
17601-3027
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-7319
  • Fax: 717-569-2313
Mailing address:
  • Phone: 717-569-7319
  • Fax: 717-569-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS029935L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDS029935L
License Number StatePA

VIII. Authorized Official

Name: DR. JENNIFER ONG PO
Title or Position: GENERAL PRACTITIONER
Credential: D.M.D.
Phone: 717-569-7319