Provider Demographics
NPI:1740358787
Name:PETROVA, KORNELIA L (DDS)
Entity type:Individual
Prefix:DR
First Name:KORNELIA
Middle Name:L
Last Name:PETROVA
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 1:3320 HATTEN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8903
Mailing Address - Country:US
Mailing Address - Phone:310-989-2645
Mailing Address - Fax:
Practice Address - Street 1:23185 HEMLOCK AVE STE 1
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8043
Practice Address - Country:US
Practice Address - Phone:951-243-1000
Practice Address - Fax:951-924-7384
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist