Provider Demographics
NPI:1811090178
Name:ROARK, CINDY (DMD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 W BOY SCOUT BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1421
Mailing Address - Country:US
Mailing Address - Phone:813-288-1999
Mailing Address - Fax:
Practice Address - Street 1:4010 W BOY SCOUT BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5727
Practice Address - Country:US
Practice Address - Phone:813-288-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000008295122300000X
GADN0132931223G0001X
FL165901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001835600Medicaid