Provider Demographics
NPI:1497157093
Name:PETROS, ANGELA DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DANIELLE
Last Name:PETROS
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 1:902 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1406
Mailing Address - Country:US
Mailing Address - Phone:304-845-9665
Mailing Address - Fax:
Practice Address - Street 1:902 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1406
Practice Address - Country:US
Practice Address - Phone:304-845-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4116122300000X
PADS040158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist