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General NPI Number Information
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NPI Number | 1487678876
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Entity Type | Organization
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Legal Business Name | MAIN STREET FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 152 MAIN STREET
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City | MONTPELIER
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State | VT
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Zip | 05602
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Country | US
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Telephone | 802-229-0690
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Fax | 802-229-4793
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Provider Business Mailing Address
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Address Line | 152 MAIN STREET
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City | MONTPELIER
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State | VT
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Zip | 05602
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Country | US
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Telephone | 802-229-0690
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Fax | 802-229-4793
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CASSANDRA PIEPER LANSKY
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Credential | D.D.S.
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Telephone | 802-229-0690
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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 | 2028
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2062
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License Number State | VT
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