Provider Demographics
NPI:1164590998
Name:POCONO KIDS DENTAL
Entity Type:Organization
Organization Name:POCONO KIDS DENTAL
Other - Org Name:LEHIGH VALLEY HOSPITAL POCONO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-862-3943
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4938
Mailing Address - Fax:570-420-4948
Practice Address - Street 1:175 E BROWN ST STE 114
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-476-3506
Practice Address - Fax:570-421-9014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POCONO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty