Provider Demographics
NPI:1831755156
Name:RASK, CINDY (DMD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:RASK
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 1:510 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2654
Mailing Address - Country:US
Mailing Address - Phone:786-210-3040
Mailing Address - Fax:
Practice Address - Street 1:775 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3812
Practice Address - Country:US
Practice Address - Phone:678-839-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11262202-99211223G0001X
GADN1230151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice