| Edison Mall Dental P.a | |
|
4125 Cleveland Ave Suite 1430 Fort Myers FL 33901-9046 | |
| (954) 846-7171 | |
| Not Available |
| Full Name | Edison Mall Dental P.a |
|---|---|
| Speciality | Dentist |
| Location | 4125 Cleveland Ave, Fort Myers, Florida |
| Authorized Official Name and Position | Rostislav Krasnov (DDS) |
| Authorized Official Contact | 9548467171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edison Mall Dental P.a 4125 Cleveland Ave Suite 1430 Fort Myers FL 33901-9046 Ph: (954) 846-7171 | Edison Mall Dental P.a 4125 Cleveland Ave Suite 1430 Fort Myers FL 33901-9046 Ph: (954) 846-7171 |
| NPI Number | 1831500404 |
|---|---|
| Provider Enumeration Date | 05/16/2014 |
| Last Update Date | 05/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831500404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN16377 (Florida) | Primary |
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