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General NPI Number Information
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NPI Number | 1164590998
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Entity Type | Organization
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Legal Business Name | POCONO KIDS DENTAL
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 175 E BROWN ST STE 114
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3098
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Country | US
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Telephone | 570-476-3506
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Fax | 570-421-9014
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Provider Business Mailing Address
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Address Line | 206 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3006
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Country | US
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Telephone | 570-420-4938
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Fax | 570-420-4948
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Authorized Official
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Title or Position | SR VP & CFO
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Name | THOMAS MARCHOZZI
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Credential |
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Telephone | 484-862-3943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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