Provider Demographics
NPI:1154530491
Name:PETROVITCH, CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:PETROVITCH
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 1:3930 KNOWLES AVE
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2428
Mailing Address - Country:US
Mailing Address - Phone:301-933-0038
Mailing Address - Fax:
Practice Address - Street 1:3930 KNOWLES AVE
Practice Address - Street 2:SUITE # 300
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:301-933-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD95141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics