# POCONO ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346445947
- **Authorized official:** MRS. SUSAN POLITO (OFFICE MANAGER)
- **Authorized official phone:** (845) 343-7529

## Contact information

- **Practice address:** 451 EAST MAIN STREET, MIDDLETOWN, NY 10940
- **Practice address phone:** (845) 343-7529
- **Practice address fax:** (845) 343-7532
- **Mailing address:** 451 EAST MAIN STREET, MIDDLETOWN, NY 10940
- **Mailing address phone:** (845) 343-7529
- **Mailing address fax:** (845) 343-7532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 044627-1 | NY | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 045048-1 | NY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 051165 | NY | — |

## Other

- **Enumeration date:** 06/15/2007
- **Last updated:** 04/24/2008