# CDA LAKE WINOLA LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CDA LAKE WINOLA LLC
- **Other names:** Century Dental Lake Winola
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104491653
- **Legal business name:** CDA LAKE WINOLA LLC
- **Authorized official:** DR. JASON J HANYON DMD (OWNER)
- **Authorized official phone:** (570) 378-3305

## Contact information

- **Practice address:** 1220 PA-307, FACTORYVILLE, PA 18419
- **Practice address phone:** (570) 378-3305
- **Practice address fax:** (570) 378-3430
- **Mailing address:** 1220 PA-307, FACTORYVILLE, PA 18419
- **Mailing address phone:** (570) 378-3305
- **Mailing address fax:** (570) 378-3430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/26/2021
- **Last updated:** 05/26/2021