Active NPI
Cross County Mall Dental, PA
- Dentist
- West Palm Beach, FL
National Provider Identifier
1972815991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- CROSS COUNTY MALL DENTAL, PA
- Practice address
- 4288 Okeechobee Blvd
West Palm Beach, FL 33409-3206 - Phone
- (561) 683-6247
- Fax
- (561) 683-6248
- NPI assigned
- Jul 7, 2010
- Last updated
- Dec 3, 2018
- Organization subpart
- No
NPPES NPI Registry
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
- (561) 683-6247
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NU | Primary |
Addresses
Primary practice location
4288 Okeechobee Blvd
West Palm Beach, FL 33409-3206
Mailing address
8422 Okeechobee Boulevard
West Palm Beach, FL 33409
Phone (561) 683-6247
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076461200 | Medicaid | FL |
National Provider Directory
National Provider Directory- Tax ID family
- Cross County Mall Dental PA
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- West Palm Beach, FL
- NPI 1841492634
Locations
4288 Okeechobee Blvd
West Palm Beach, FL 33409
Phone (561) 683-6247
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- West Palm Beach, FL
- NPI 1013910025
-
- Dentist
- West Palm Beach, FL
- NPI 1437521580
-
- General Practice Dentistry
- Coconut Creek, FL
- NPI 1548782600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278460800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1543795200000",
"number": "1972815991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8422 OKEECHOBEE BOULEVARD",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33409",
"telephone_number": "561-683-6247",
"fax_number": "561-683-6248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4288 OKEECHOBEE BLVD",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334093206",
"telephone_number": "561-683-6247",
"fax_number": "561-683-6248"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CROSS COUNTY MALL DENTAL, PA",
"organizational_subpart": "NO",
"enumeration_date": "2010-07-07",
"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": "561-683-6247",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "076461200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Palm Beach, FL
Sources for this page
- 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.