| NPI | 1700397031 |
|---|---|
| Doing Business As | LINCOLNWOOD MALL DENTAL |
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV KRASNOV Owner 786-475-7600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2017-10-13 |