Pembroke Lakes Mall Dental PA
NPI #1144945882 in Pembroke Pines, Florida
Provider Information
- NPI Number
- 1144945882
- Entity Type
- Organization
- Organization Name
- Pembroke Lakes Mall Dental PA
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Oct 5, 2022
- Last Updated
- Oct 12, 2022
Practice Location
- Address
- 11401 PINES BLVD STE 220
- City
- Pembroke Pines
- State
- Florida
- ZIP Code
- 33026-4104
- Phone
- (954) 573-1400
Authorized Official
- Name
- ROSTISLAV KRASNOV, DMD
- Title
- OWNER
- Phone
- (954) 573-1400
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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