Provider Demographics
NPI:1396259628
Name:PETROVA, ADELINA (DENTIST DMD)
Entity type:Individual
Prefix:MRS
First Name:ADELINA
Middle Name:
Last Name:PETROVA
Suffix:
Gender:F
Credentials:DENTIST DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE C105
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-260-3777
Mailing Address - Fax:512-260-1238
Practice Address - Street 1:401 E WHITESTONE BLVD
Practice Address - Street 2:SUITE C105
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-260-3777
Practice Address - Fax:512-260-1238
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336031223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice