Provider Demographics
NPI:1467012153
Name:STEFKA PETROVA DDS, A PROFESSIONAL DENTAL ORGANIZATION
Entity Type:Organization
Organization Name:STEFKA PETROVA DDS, A PROFESSIONAL DENTAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-982-2250
Mailing Address - Street 1:450 SUTTER ST RM 1220
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4001
Mailing Address - Country:US
Mailing Address - Phone:415-982-2250
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1220
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4001
Practice Address - Country:US
Practice Address - Phone:415-982-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental