| NPI | 1538255856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN CLEMENS Office Manager 570-724-2565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS027194L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS027186L) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |