MEDICARE: DR. CINDY RASK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11262202-9921	UT
2	1223G0001X	General Practice Dentistry	DN123015	GA

General Provider Information

NPI Number	:	1831755156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CINDY RASK DMD

Provider Business Mailing Address
First Line	:	510 SPRINGDALE DR
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-2654
Country	:	US
Telephone Number	:	786-210-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 S PARK ST
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3812
Country	:	US
Telephone Number	:	678-839-0031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	03/13/2024

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