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General NPI Number Information
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NPI Number | 1659851384
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Entity Type | Individual
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Provider Name | MARIA F PETROCHE DMD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 11/06/2022
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Provider Practice Location Address
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Address Line | 7384 S ALTON WAY STE 101
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City | CENTENNIAL
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State | CO
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Zip | 80112-2369
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Country | US
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Telephone | 303-721-1173
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 S PARK TERRACE AVE
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3344
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Country | US
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Telephone | 352-470-4622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 204861
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858104
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License Number State | MA
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