| NPI | 1801263090 |
|---|---|
| Doing Business As | LINCOLNWOOD MALL DENTAL |
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV KRASNOV President 786-475-7600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.028976) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |