Willowbrook Mall Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16377 Issued in FL

Legal business name

WILLOWBROOK MALL DENTAL

Practice address

1684 Willowbrook Mall
Houston, TX 77070-6027

Phone

(917) 902-9515

NPI assigned

Feb 21, 2013

Last updated

Feb 21, 2013By the provider in NPPES

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

(917) 902-9515

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1316287717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 WILLOWBROOK MALL",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770706027",
            "telephone_number": "917-902-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 WILLOWBROOK MALL",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770706027",
            "telephone_number": "917-902-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWBROOK MALL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-902-9515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willowbrook EMS
• Willowbrook EMS Group Inc (Willowbrook EMS)
• Willowbrook Eye Associates PLLC
• Willowbrook Imaging LLC
• Willowbrook Infusion Center, PA
• Willowbrook MRI
• Willowbrook Procedure Centers, LP
• Willowbrook Psychological Associates, PC
• Willowbrook SNF Management LLC (Willowbrook Residence and Rehabilitation Center)
• Willowbrook Spine Center, P.a. (The Spine Center)

• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.