Provider Demographics
NPI:1245386077
Name:PETROFF, HEATHER JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JEAN
Last Name:PETROFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ROYALTON RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2597
Mailing Address - Country:US
Mailing Address - Phone:440-838-4480
Mailing Address - Fax:
Practice Address - Street 1:500 E ROYALTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2597
Practice Address - Country:US
Practice Address - Phone:440-838-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice