Cda Lake Winola LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CDA LAKE WINOLA LLC

Doing business as

Century Dental Lake Winola

Practice address

1220 PA-307
Factoryville, PA 18419

Phone

(570) 378-3305

Fax

(570) 378-3430

NPI assigned

May 26, 2021

Last updated

May 26, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

CDA LAKE WINOLA LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jason J Hanyon, DMD

Title

Owner

Phone

(570) 378-3305

Specialties & licenses 1

Addresses

Other names 1

• Century Dental Lake Winola Doing business as

Part of

Cda Lake Winola LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1104491653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 PA-307",
            "city": "FACTORYVILLE",
            "state": "PA",
            "postal_code": "18419",
            "telephone_number": "570-378-3305",
            "fax_number": "570-378-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 PA-307",
            "city": "FACTORYVILLE",
            "state": "PA",
            "postal_code": "18419",
            "telephone_number": "570-378-3305",
            "fax_number": "570-378-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDA LAKE WINOLA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CDA LAKE WINOLA LLC",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "HANYON",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-378-3305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Century Dental Lake Winola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Appleby, MS,OTR/L
• Marissa Ashley Brink, MSOTRL
• Elizabeth Ann Connolly, LCSW
• Shawna Darling, PHARMD
• Darlings Pharmacy (Darling's Family Pharmacy)
• Thomas Anthony Dellaglio, DDS
• Sheila Donnelly, RD,LDN

• General Practice Dentistry in Factoryville, PA
• Providers in Factoryville, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.