MEDICARE: POCONO DENTAL

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	1223G0001X	General Practice Dentistry	DS023437L	PA
2	1223G0001X	General Practice Dentistry	DSO14501L	PA
3	1223G0001X	General Practice Dentistry	DS030377L	PA

General Provider Information

NPI Number	:	1316092919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO DENTAL

Provider Business Mailing Address
First Line	:	243 E BROWN ST
Second Line	:
City	:	E STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	570-424-1201
Fax Number	:	570-476-8841

Provider Business Practice Location Address
First Line	:	243 E BROWN ST
Second Line	:
City	:	E STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	570-424-1201
Fax Number	:	570-476-8841

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT P HOSKO
Credential	:	D.D.S, FAGD
Telephone Number	:	570-424-1201

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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Directions to “POCONO DENTAL ” Practice Location

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