Healthcare Provider Details

I. General information

NPI: 1174547558
Provider Name (Legal Business Name): CASSANDRA P COAKLEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA P LANSKY D.D.S.

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MAIN ST
MONTPELIER VT
05602-2913
US

IV. Provider business mailing address

PO BOX 204
WATERBURY CENTER VT
05677-0204
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0690
  • Fax: 802-229-4793
Mailing address:
  • Phone: 802-244-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2062
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: