| Staten Island Mall Dental, P.c. | |
|
2655 Richmond Avenue 2220 Staten Island NY 10314 | |
| (718) 982-5500 | |
| (718) 982-5554 |
| Full Name | Staten Island Mall Dental, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 2655 Richmond Avenue, Staten Island, New York |
| Authorized Official Name and Position | Ross Krasnov (DENTIST) |
| Authorized Official Contact | 7189825500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Staten Island Mall Dental, P.c. 2655 Richmond Avenue 2220 Staten Island NY 10314 Ph: (718) 982-5500 | Staten Island Mall Dental, P.c. 2655 Richmond Avenue 2220 Staten Island NY 10314 Ph: (718) 982-5500 |
| NPI Number | 1013139237 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013139237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 046-043 (New York) | Primary |
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