Provider Demographics
NPI:1285703702
Name:PETROV, SOFIA D (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:D
Last Name:PETROV
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27081 185TH AVE SE
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8448
Mailing Address - Country:US
Mailing Address - Phone:253-981-4950
Mailing Address - Fax:253-981-4952
Practice Address - Street 1:27081 185TH AVE SE STE B-105
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-8448
Practice Address - Country:US
Practice Address - Phone:253-981-4950
Practice Address - Fax:253-981-4952
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics