Provider Demographics
NPI:1891541165
Name:PETROFF, DALLAS JAMES (DO)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:JAMES
Last Name:PETROFF
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 HOLLY TRL
Mailing Address - Street 2:
Mailing Address - City:OGILVIE
Mailing Address - State:MN
Mailing Address - Zip Code:56358-3652
Mailing Address - Country:US
Mailing Address - Phone:763-244-0427
Mailing Address - Fax:
Practice Address - Street 1:1401 E CENTRAL DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8046
Practice Address - Country:US
Practice Address - Phone:208-795-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program