Provider Demographics
NPI:1568824498
Name:PO DENTISTRY LLC
Entity Type:Organization
Organization Name:PO DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ONG
Authorized Official - Last Name:PO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-569-7319
Mailing Address - Street 1:1661 MANHEIM PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3027
Mailing Address - Country:US
Mailing Address - Phone:717-569-7319
Mailing Address - Fax:717-569-2313
Practice Address - Street 1:1661 MANHEIM PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3027
Practice Address - Country:US
Practice Address - Phone:717-569-7319
Practice Address - Fax:717-569-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029935L122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty