# POCONO PINES DENTAL LLC

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

## Provider details

- **NPI number:** 1750789087
- **Authorized official:** DR. JOHN MANN DMD (MEMBER)
- **Authorized official phone:** (570) 646-7811

## Contact information

- **Practice address:** 395 ROUTE 940, SUITE 102, BLAKESLEE, PA 18610
- **Practice address phone:** (570) 646-7811
- **Mailing address:** PO BOX 1005, 395 ROUTE 940 SUITE 102, BLAKESLEE, PA 18610
- **Mailing address phone:** (570) 646-7811
- **Mailing address fax:** (570) 643-9747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS035165 | NULL | — |
| 122300000X | Dentist | DS035165 | — | — |
| 122300000X | Dentist | DS03529 | NULL | Yes |
| 122300000X | Dentist | DS03529 | — | Yes |

## Other

- **Enumeration date:** 12/19/2014
- **Last updated:** 12/19/2014