| NPI | 1861732273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV KRASNOV Owner 917-902-9515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16377) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2014-12-04 |