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General NPI Number Information
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NPI Number | 1144692476
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Entity Type | Organization
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Legal Business Name | COAKLEY FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 33 ELECTRIC AVE SUITE 102
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City | FITCHBURG
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State | MA
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Zip | 01420-7954
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Country | US
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Telephone | 978-343-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 33 ELECTRIC AVE SUITE 102
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City | FITCHBURG
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State | MA
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Zip | 01420-7954
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Country | US
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Telephone | 978-343-3646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM JOHN COAKLEY III
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Credential | D.M.D.
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Telephone | 978-343-3646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20549
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License Number State | MA
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