Organization
GALLERIA MALL DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS KRASNOV (OFFICE ADMINISTRATOR)
(845) 692-9212
Entity
Organization
Contact information
Practice address
1 N GALLERIA DR STE 141, MIDDLETOWN, NY 10941-3030
(845) 692-9212
(845) 692-9215
Mailing address
1 N GALLERIA DR STE 141, MIDDLETOWN, NY 10941-3030
(845) 692-9212
(845) 692-9215
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
049213
NY
122300000X
Dentist
052828
NY
1223P0221X
Pediatric Dentistry
048760
NY
1223P0300X
Periodontics
Primary
042707
NY
Other
Enumeration date
04/20/2007
Last updated
09/11/2025
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