MEDICARE: RAYA PETROV D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8044	CO

General Provider Information

NPI Number	:	1699773838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYA PETROV D.D.S.

Provider Business Mailing Address
First Line	:	7048 S DUDLEY ST
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-4251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 W JEWELL AVE
Second Line	:	#D
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6891
Country	:	US
Telephone Number	:	303-988-2920
Fax Number	:	303-988-3226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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