Provider Demographics
NPI:1235394172
Name:KRYKHTIN, PAVEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:A
Last Name:KRYKHTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 YAMATO RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4704
Mailing Address - Country:US
Mailing Address - Phone:518-727-6429
Mailing Address - Fax:
Practice Address - Street 1:222 YAMATO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4704
Practice Address - Country:US
Practice Address - Phone:518-727-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539121223G0001X
FLDN18905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice