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Organization
SOUTHLAND MALL DENTAL,P.A.
Active
Organization
SOUTHLAND MALL DENTAL,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV DDS (OWNER)
(305) 245-0308
Entity
Organization
Contact information
Practice address
20505 S DIXIE HWY, STE 1683, CUTLER BAY, FL 33189-1229
(305) 245-0308
(954) 846-7170
Mailing address
20505 S DIXIE HWY, STE 1683, CUTLER BAY, FL 33189-1229
(305) 245-0308
(954) 846-7170
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/20/2012
Last updated
12/03/2018
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