Organization
BOYNTON BEACH MALL DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV (OWNER)
(561) 369-7199
Entity
Organization
Contact information
Practice address
801 N CONGRESS AVE STE 185D, BOYNTON BEACH, FL 33426-3364
(561) 369-7199
Mailing address
801 N CONGRESS AVE STE 185D, BOYNTON BEACH, FL 33426-3364
(561) 369-7199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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