Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Countryside Mall Dental PA

Organization General Practice Dentistry · NPI 1568023067

Countryside Mall Dental PA is a General Practice Dentistry in Clearwater, Florida. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

27001 US Highway 19 N Ste 1031B
Clearwater, FL 33761-3407
Phone: (727) 669-1600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1568023067
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rostislav Krasnov — Owner · (727) 669-1600
NPI enumeratedJune 25, 2019
Last updated in NPPESJune 25, 2019
Mailing address27001 Us Highway 19 N Ste 1031b, Clearwater, FL 33761-3407

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