Organization
DAVID HENRY DDS AND RANDELL ROARK DDS INC.
Active
Other names
Cricket Lane Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDELL SCOTT ROARK DDS (DENTIST/ VICE PRESIDENT)
(910) 584-6894
Entity
Organization
Contact information
Practice address
1041 CRICKET LN, MANSFIELD, OH 44906-4105
(419) 526-4249
Mailing address
1041 CRICKET LN, MANSFIELD, OH 44906-4105
(419) 526-4249
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21772
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076483
—
OH
05
—
0489403
—
OH
05
—
2860159
—
OH
Enumeration date
06/12/2014
Last updated
06/12/2014
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