Regency Square Mall Dental

Primary specialty

DentistTaxonomy code 122300000X

License

DN16377 Issued in FL

Legal business name

REGENCY SQUARE MALL DENTAL

Practice address

9501 Arlington Expy
Ste#0345
Jacksonville, FL 32225-8200

Phone

(904) 727-6055

NPI assigned

Jul 24, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Rostislav Krasnov, DDS

Title

Owner

Phone

(904) 727-6055

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1033465349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 ARLINGTON EXPY",
            "address_2": "STE#0345",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322258200",
            "telephone_number": "904-727-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 ARLINGTON EXPY",
            "address_2": "STE#0345",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322258200",
            "telephone_number": "904-727-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY SQUARE MALL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-727-6055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Shannon Regan
• Eric James Regele, MD
• Laura S Regele, DNP
• Regency Eye Care LLC
• Regency Modern Dentistry, PA
• Regenerative Medicine of North Florida LLC
• Reginald L. Sykes, Sr, M.D., P.a.
• Regional Care Transportation LLC
• Regional Consultants in Hematology Oncology, Inc.
• Regional MRI of Jacksonville

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.