Southland Mall Dental,P.a.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SOUTHLAND MALL DENTAL,P.A.

Practice address

20505 S Dixie Hwy
Ste 1683
Cutler Bay, FL 33189-1229

Phone

(305) 245-0308

Fax

(954) 846-7170

NPI assigned

Feb 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rostislav Krasnov, DDS

Title

Owner

Phone

(305) 245-0308

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1023381183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20505 S DIXIE HWY",
            "address_2": "STE 1683",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331891229",
            "telephone_number": "305-245-0308",
            "fax_number": "954-846-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20505 S DIXIE HWY",
            "address_2": "STE 1683",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331891229",
            "telephone_number": "305-245-0308",
            "fax_number": "954-846-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND MALL DENTAL,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-20",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-245-0308",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Cutler Bay, FL
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• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.