| Pembroke Lakes Mall Dental Pa | |
|
11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4104 | |
| (954) 573-1400 | |
| Not Available |
| Full Name | Pembroke Lakes Mall Dental Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11401 Pines Blvd Ste 220, Pembroke Pines, Florida |
| Authorized Official Name and Position | Rostislav Krasnov (OWNER) |
| Authorized Official Contact | 9545731400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pembroke Lakes Mall Dental Pa 11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4104 Ph: () - | Pembroke Lakes Mall Dental Pa 11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4104 Ph: (954) 573-1400 |
| NPI Number | 1144945882 |
|---|---|
| Provider Enumeration Date | 10/05/2022 |
| Last Update Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144945882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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