Provider Demographics
NPI:1134565286
Name:PETROV, GEORGI P (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGI
Middle Name:P
Last Name:PETROV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 SAINT JAMES ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-2169
Mailing Address - Country:US
Mailing Address - Phone:919-200-0377
Mailing Address - Fax:
Practice Address - Street 1:1212 FREEWAY DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7170
Practice Address - Country:US
Practice Address - Phone:336-342-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice