| Cricket Lane Dental | |
|
1041 Cricket Ln Mansfield OH 44906-4105 | |
| (419) 526-4249 | |
| Not Available |
| Full Name | Cricket Lane Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1041 Cricket Ln, Mansfield, Ohio |
| Authorized Official Name and Position | Randell Scott Roark (DENTIST/ VICE PRESIDENT) |
| Authorized Official Contact | 9105846894 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cricket Lane Dental 1041 Cricket Ln Mansfield OH 44906-4105 Ph: (419) 526-4249 | Cricket Lane Dental 1041 Cricket Ln Mansfield OH 44906-4105 Ph: (419) 526-4249 |
| NPI Number | 1497169932 |
|---|---|
| Provider Enumeration Date | 06/12/2014 |
| Last Update Date | 06/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497169932 | NPI | - | NPPES |
| 0076483 | Medicaid | OH | |
| 0489403 | Medicaid | OH | |
| 2860159 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 21772 (Ohio) | Primary |
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