Staten Island Mall Dental, P.c. | |
2655 Richmond Avenue 2220 Staten Island NY 10314 | |
(718) 982-5500 | |
(718) 982-5554 |
Full Name | Staten Island Mall Dental, P.c. |
---|---|
Speciality | Dentist |
Location | 2655 Richmond Avenue, Staten Island, New York |
Authorized Official Name and Position | Ross Krasnov (DENTIST) |
Authorized Official Contact | 7189825500 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Staten Island Mall Dental, P.c. 2655 Richmond Avenue 2220 Staten Island NY 10314 Ph: (718) 982-5500 | Staten Island Mall Dental, P.c. 2655 Richmond Avenue 2220 Staten Island NY 10314 Ph: (718) 982-5500 |
NPI Number | 1013139237 |
---|---|
Provider Enumeration Date | 05/03/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013139237 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 046-043 (New York) | Primary |
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