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General NPI Number Information
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NPI Number | 1235394172
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Entity Type | Individual
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Provider Name | PAVEL A KRYKHTIN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 10/07/2012
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Provider Practice Location Address
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Address Line | 222 YAMATO RD SUITE 109
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City | BOCA RATON
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State | FL
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Zip | 33431-4704
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Country | US
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Telephone | 518-727-6429
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Fax |
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Provider Business Mailing Address
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Address Line | 222 YAMATO RD SUITE 109
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City | BOCA RATON
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State | FL
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Zip | 33431-4704
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Country | US
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Telephone | 518-727-6429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 053912
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN18905
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License Number State | FL
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