Provider Demographics
NPI:1154710556
Name:PETROS, SAHAR (DMD)
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:PETROS
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 1:4330 W. UNION HILLS
Mailing Address - Street 2:SUITE #B18
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-582-6666
Mailing Address - Fax:623-582-6665
Practice Address - Street 1:4330 W. UNION HILLS
Practice Address - Street 2:SUITE #B18
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-582-6666
Practice Address - Fax:623-582-6665
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist