| NPI | 1154738151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV KRASNOV Owner 954-846-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27827) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |