Provider Demographics
NPI:1881098531
Name:PETROV, VELIZAR (DMD)
Entity type:Individual
Prefix:DR
First Name:VELIZAR
Middle Name:
Last Name:PETROV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3520
Mailing Address - Country:US
Mailing Address - Phone:216-251-8812
Mailing Address - Fax:216-252-2448
Practice Address - Street 1:3447 W 117TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3520
Practice Address - Country:US
Practice Address - Phone:216-251-8812
Practice Address - Fax:216-252-2448
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH242781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice