Brandon Mall Dental P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

DN16377 Issued in FL

Legal business name

BRANDON MALL DENTAL P.A.

Practice address

675 Brandon Town Center Mall
Brandon, FL 33511-4770

Phone

(954) 846-7171

NPI assigned

May 16, 2014

Last updated

May 16, 2014By 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

Rostislav Krasnov, DENTIST

Title

DDS

Phone

(954) 846-7171

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400198400000",
    "number": "1922419597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 BRANDON TOWN CENTER MALL",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114770",
            "telephone_number": "954-846-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 BRANDON TOWN CENTER MALL",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114770",
            "telephone_number": "954-846-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON MALL DENTAL P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-16",
        "last_updated": "2014-05-16",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "954-846-7171",
        "authorized_official_credential": "DENTIST"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Health Opco, LLC (Brandon Center for Nursing & Rehabilitation)
• Brandon Home Care LLC (Home Instead)
• Brandon Home Care LLC (Home Instead)
• Brandon Integrated Healthcare Clinics Inc
• Brandon Integrative Health LLC
• Brandon Medical Care LLC (Brandon Medical Care)
• Brandon Medical Center
• Brandon Medical Wellness Center (Physical Medicine & Rehabilitation)
• Brandon Mental Health
• Brandon Modern Dentistry, PA (Brandon Modern Dentistry)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.