Broward Mall Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BROWARD MALL DENTAL, PA

Practice address

8000 W Broward Blvd Ste 834
Plantation, FL 33388-0023

Phone

(954) 476-0802

NPI assigned

Apr 10, 2007

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) 476-0802

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephane Dieudonne, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Plantation, FL
  • NPI 1548431026
  NPD (past)
• Marina Spektor, DDS

  • Public Health Dentistry
  • Richmond, VA
  • NPI 1710114822
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1376766568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 W BROWARD BLVD STE 834",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333880023",
            "telephone_number": "954-476-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 W BROWARD BLVD STE 834",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333880023",
            "telephone_number": "954-476-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROWARD MALL DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "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": "954-476-0802",
        "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": []
}

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• Broward Institute of Cardiology, Inc
• Broward Intensivist Group LLC
• Broward Medical Associates of South Florida,Inc
• Broward Neurosurgeons LLC
• Broward Primary Care Clinics Inc
• Broward Therapists, PLLC
• Broward Therapy Specialists, PA

• General Practice Dentistry in Plantation, FL
• Providers in Plantation, 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 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.