Provider Demographics
NPI:1508957390
Name:PETROVA, NATALIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:PETROVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 W SAN MARCOS BLVD #106
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1136
Mailing Address - Country:US
Mailing Address - Phone:760-761-0905
Mailing Address - Fax:760-761-0906
Practice Address - Street 1:997 W SAN MARCOS BLVD #106
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1136
Practice Address - Country:US
Practice Address - Phone:760-761-0905
Practice Address - Fax:760-761-0906
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health