Brandon Mall Dental P.a.

NPI #1922419597 in Brandon, Florida

Provider Information

NPI Number: 1922419597
Entity Type: Organization
Organization Name: Brandon Mall Dental P.a.
Primary Specialty: Dentist
Enumeration Date: May 16, 2014
Last Updated: May 16, 2014

Practice Location

Address: 675 BRANDON TOWN CENTER MALL
City: Brandon
State: Florida
ZIP Code: 33511-4770
Phone: (954) 846-7171

Authorized Official

Name: ROSTISLAV KRASNOV, DENTIST
Title: DDS
Phone: (954) 846-7171

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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