Organization
FIRST COLONY MALL DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV DDS (OWNER)
(954) 846-7171
Entity
Organization
Contact information
Practice address
16535 SOUTHWEST FWY, 570, SUGAR LAND, TX 77479-2321
(954) 846-7171
Mailing address
16535 SOUTHWEST FWY, 570, SUGAR LAND, TX 77479-2321
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
27827
TX
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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