Provider Demographics
NPI:1174547558
Name:COAKLEY, CASSANDRA P (DDS)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:P
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CASSANDRA
Other - Middle Name:P
Other - Last Name:LANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-0204
Mailing Address - Country:US
Mailing Address - Phone:802-244-7208
Mailing Address - Fax:
Practice Address - Street 1:152 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2913
Practice Address - Country:US
Practice Address - Phone:802-229-0690
Practice Address - Fax:802-229-4793
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT20621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice