Organization
CROSS COUNTY MALL DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV DDS (OWNER)
(561) 683-6247
Entity
Organization
Contact information
Practice address
4288 OKEECHOBEE BLVD, WEST PALM BEACH, FL 33409-3206
(561) 683-6247
(561) 683-6248
Mailing address
8422 OKEECHOBEE BOULEVARD, WEST PALM BEACH, FL 33409
(561) 683-6247
(561) 683-6248
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076461200
—
FL
Enumeration date
07/07/2010
Last updated
12/03/2018
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