Provider Demographics
NPI:1417967241
Name:PO, JENNIFER ONG (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ONG
Last Name:PO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ONG
Other - Last Name:POVELASCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1641 A MANHEIM PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-569-7319
Mailing Address - Fax:717-569-2313
Practice Address - Street 1:1641 A MANHEIM PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-569-7319
Practice Address - Fax:717-569-2313
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029935L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice