Boynton Beach Mall Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BOYNTON BEACH MALL DENTAL PA

Practice address

801 N Congress Ave Ste 185D
Boynton Beach, FL 33426-3364

Phone

(561) 369-7199

NPI assigned

Jun 25, 2019

Organization subpart

No

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

Authorized official

Name

Rostislav Krasnov

Title

Owner

Phone

(561) 369-7199

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Bisma Zaman, DMD

  • Dentist
  • Boynton Beach, FL
  • NPI 1497478507
  NPD (past)

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1861053480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N CONGRESS AVE STE 185D",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334263364",
            "telephone_number": "561-369-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N CONGRESS AVE STE 185D",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334263364",
            "telephone_number": "561-369-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYNTON BEACH MALL DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-369-7199"
    },
    "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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• General Practice Dentistry in Boynton Beach, FL
• Providers in Boynton Beach, 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 25, 2019; 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.