| NPI | 1497169932 |
|---|---|
| Doing Business As | CRICKET LANE DENTAL |
| Entity Type | Organization |
| Authorized Contact | RANDELL SCOTT ROARK Dentist/ Vice President 910-584-6894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 21772) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |