# POCONO ORAL SURGERY

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

## Provider details

- **NPI number:** 1831393685
- **Authorized official:** TERESA NILES (RECEPTIONIST)
- **Authorized official phone:** (570) 253-4000

## Contact information

- **Practice address:** 1095 TEXAS PALMYRA HWY, SUITE M, HONESDALE, PA 18431-7672
- **Practice address phone:** (570) 253-4000
- **Mailing address:** 1095 TEXAS PALMYRA HWY, SUITE M, HONESDALE, PA 18431-7672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | BL5871187 | PA | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | DS020813L | PA | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | DS035287 | PA | — |

## Other

- **Enumeration date:** 06/14/2007
- **Last updated:** 07/25/2007