Provider Demographics
NPI:1487678876
Name:MAIN STREET FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:MAIN STREET FAMILY DENTISTRY, PC
Other - Org Name:JOHN R. LANSKY DDS FAMILY DENTISTRY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:PIEPER
Authorized Official - Last Name:LANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-229-0690
Mailing Address - Street 1:152 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-229-0690
Mailing Address - Fax:802-229-4793
Practice Address - Street 1:152 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-229-0690
Practice Address - Fax:802-229-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT20281223G0001X
VT20621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty