Provider Demographics
NPI:1306531587
Name:CRICKET DENTAL PLLC
Entity type:Organization
Organization Name:CRICKET DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-821-9212
Mailing Address - Street 1:6 BIRNAMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2415
Mailing Address - Country:US
Mailing Address - Phone:870-821-9212
Mailing Address - Fax:870-633-8460
Practice Address - Street 1:408 PORTER ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3216
Practice Address - Country:US
Practice Address - Phone:870-633-4591
Practice Address - Fax:870-633-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental