First Colony Mall Dental PA
NPI #1154738151 in Sugar Land, Texas
Provider Information
- NPI Number
- 1154738151
- Entity Type
- Organization
- Organization Name
- First Colony Mall Dental PA
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jul 22, 2014
- Last Updated
- Jul 22, 2014
Practice Location
- Address
- 16535 SOUTHWEST FWY
- Address 2
- 570
- City
- Sugar Land
- State
- Texas
- ZIP Code
- 77479-2321
- Phone
- (954) 846-7171
Authorized Official
- Name
- ROSTISLAV KRASNOV, DDS
- Title
- OWNER
- Phone
- (954) 846-7171
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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