Organization
BROWARD MALL DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV DDS (OWNER)
(954) 476-0802
Entity
Organization
Contact information
Practice address
8000 W BROWARD BLVD STE 834, PLANTATION, FL 33388-0023
(954) 476-0802
Mailing address
8000 W BROWARD BLVD STE 834, PLANTATION, FL 33388-0023
(954) 476-0802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/10/2007
Last updated
12/03/2018
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