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Organization
WILLOWBROOK MALL DENTAL
Active
Organization
WILLOWBROOK MALL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSTISLAV KRASNOV DDS (OWNER)
(917) 902-9515
Entity
Organization
Contact information
Practice address
1684 WILLOWBROOK MALL, HOUSTON, TX 77070-6027
(917) 902-9515
Mailing address
1684 WILLOWBROOK MALL, HOUSTON, TX 77070-6027
(917) 902-9515
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN16377
FL
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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