Organization
EDISON MALL DENTAL P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV DENTIST (DDS)
(954) 846-7171
Entity
Organization
Contact information
Practice address
4125 CLEVELAND AVE, SUITE 1430, FORT MYERS, FL 33901-9046
(954) 846-7171
Mailing address
4125 CLEVELAND AVE, SUITE 1430, FORT MYERS, FL 33901-9046
(954) 846-7171
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16377
FL
Other
Enumeration date
05/16/2014
Last updated
05/16/2014
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