Provider Demographics
NPI:1407633373
Name:GAGNON, CASSANDRA ANN (LD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1600
Mailing Address - Country:US
Mailing Address - Phone:207-514-0660
Mailing Address - Fax:207-784-5805
Practice Address - Street 1:801 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1600
Practice Address - Country:US
Practice Address - Phone:207-514-0660
Practice Address - Fax:207-784-5805
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDTR5544122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist