| Countryside Mall Dental Pa | |
|
27001 Us Highway 19 N Ste 1031b Clearwater FL 33761-3407 | |
| (727) 669-1600 | |
| Not Available |
| Full Name | Countryside Mall Dental Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 27001 Us Highway 19 N Ste 1031b, Clearwater, Florida |
| Authorized Official Name and Position | Rostislav Krasnov (OWNER) |
| Authorized Official Contact | 7276691600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Countryside Mall Dental Pa 27001 Us Highway 19 N Ste 1031b Clearwater FL 33761-3407 Ph: (727) 669-1600 | Countryside Mall Dental Pa 27001 Us Highway 19 N Ste 1031b Clearwater FL 33761-3407 Ph: (727) 669-1600 |
| NPI Number | 1568023067 |
|---|---|
| Provider Enumeration Date | 06/25/2019 |
| Last Update Date | 06/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568023067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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