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LAJUAN M MOUNTAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
415 E BOUNDARY AVE, SUITE 101, YORK, PA 17403-2811
(717) 846-5174
(717) 845-4884
Mailing address
116 S GEORGE ST, SUITE 301, YORK, PA 17401-1408
(717) 846-8546
(717) 854-0377

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS036195
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101296402
PA
01
169245
UNISON
PA
01
1734162
UNITED CONCORDIA
PA
01
248134
DENTAL BENEFIT PROVIDERS
PA
01
9179591
DORAL DENTAL
PA
01
DS036195
DELTA DENTAL
PA
Enumeration date
06/02/2006
Last updated
08/31/2011
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