Organization
GALLERIA MALL DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS KRASNOV DDS (OWNER)
(914) 997-9000
Entity
Organization
Contact information
Practice address
100 MAIN ST, WHITE PLAINS, NY 10601-2601
(914) 997-9000
Mailing address
100 MAIN ST, WHITE PLAINS, NY 10601-2601
(914) 997-9000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
046043
NY
1223G0001X
General Practice Dentistry
050148
NY
1223G0001X
General Practice Dentistry
052112
NY
1223G0001X
General Practice Dentistry
052119
NY
1223G0001X
General Practice Dentistry
052674
NY
1223P0221X
Pediatric Dentistry
048760
NY
1223P0300X
Periodontics
042707
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
048185
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02598167
—
NY
Enumeration date
02/01/2007
Last updated
09/11/2025
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