Individual
LORI GRODACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHDHP
Contact information
Practice address
5 S WASHINGTON AVE, JERMYN, PA 18433-1121
(570) 230-0019
Mailing address
164 THE HIDEOUT, 331 CEDARWOOD TERRACE, LAKE ARIEL, PA 18436
(570) 909-6180
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
PHDH001290
PA
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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