First Colony Mall Dental PA
Dentist, General Practice in Sugar Land, TX. Organization (NPI-2).
NPI number1154738151
StatusActive
Last updated in NPPESJul 22, 2014
Details
- NPI
- 1154738151
- Entity type
- Organization (NPI-2)
- Legal business name
- First Colony Mall Dental PA
- Organization subpart
- No
- Enumeration date
- Jul 22, 2014
- Last updated
- Jul 22, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 27827 | TX | Yes |
Practice location
16535 Southwest Fwy570
Sugar Land, TX 77479-2321
Phone 954-846-7171
Mailing address
16535 Southwest Fwy570
Sugar Land, TX 77479-2321
Authorized official
Rostislav Krasnov
Owner
9548467171
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