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Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Together For Health Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 251-6641
Mailing address
600 MAPLE AVE STE 7, HONESDALE, PA 18431-1459
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007765560002
—
PA
01
—
986352
BS DENTAL PROVIDER NUMBER
PA
Enumeration date
05/23/2007
Last updated
01/14/2008
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