Provider Demographics
NPI:1659851384
Name:PETROCHE, MARIA F (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:PETROCHE
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 1:5400 S PARK TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3344
Mailing Address - Country:US
Mailing Address - Phone:352-470-4622
Mailing Address - Fax:
Practice Address - Street 1:7384 S ALTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2369
Practice Address - Country:US
Practice Address - Phone:303-721-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2048611223P0300X
MADN1858104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist