| Cda Lake Winola Llc | |
|
1220 Pa-307 Factoryville PA 18419 | |
| (570) 378-3305 | |
| (570) 378-3430 |
| Full Name | Cda Lake Winola Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1220 Pa-307, Factoryville, Pennsylvania |
| Authorized Official Name and Position | Jason J Hanyon (OWNER) |
| Authorized Official Contact | 5703783305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cda Lake Winola Llc 1220 Pa-307 Factoryville PA 18419 Ph: (570) 378-3305 | Cda Lake Winola Llc 1220 Pa-307 Factoryville PA 18419 Ph: (570) 378-3305 |
| NPI Number | 1104491653 |
|---|---|
| Provider Enumeration Date | 05/26/2021 |
| Last Update Date | 05/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104491653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |