Lauderhill Mall Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAUDERHILL MALL DENTAL, PA

Practice address

1249 NW 40TH Ave
Lauderhill, FL 33313-5801

Phone

(954) 584-2214

NPI assigned

Jun 26, 2023

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

(954) 584-2214

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1285310011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 NW 40TH AVE",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333135801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 NW 40TH AVE",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333135801",
            "telephone_number": "954-584-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUDERHILL MALL DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-584-2214",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olga Lapeyra, M.D.
• Barbara Laster
• Latson Care, LLC
• Latties Palace Services LLC
• Lauderhill Childrens Dental LLC
• Lauderhill Manor LLC
• Lauderhill Medical Center LLC
• Lauderhill Pharmacy LLC
• Lauderhill Physical Therapy, LLC
• Lavoix Health Inc

• General Practice Dentistry in Lauderhill, FL
• Providers in Lauderhill, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.