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General NPI Number Information
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NPI Number | 1760601991
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Entity Type | Organization
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Legal Business Name | JONATHAN S. PETROVER
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9804 S MILITARY TRL STE E4
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-3291
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Country | US
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Telephone | 561-364-0013
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Fax | 561-364-9292
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Provider Business Mailing Address
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Address Line | 9804 S MILITARY TRL STE E4
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-3291
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Country | US
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Telephone | 561-364-0013
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Fax | 561-364-9292
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JONATHAN S PETROVER
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Credential | DDS
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Telephone | 561-364-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN14233
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License Number State | FL
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