Provider Demographics
NPI:1013439843
Name:CASCO BAY DENTAL
Entity Type:Organization
Organization Name:CASCO BAY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-349-2401
Mailing Address - Street 1:10 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2404
Mailing Address - Country:US
Mailing Address - Phone:207-729-8939
Mailing Address - Fax:
Practice Address - Street 1:10 EVERETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2404
Practice Address - Country:US
Practice Address - Phone:207-729-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4570261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental