Individual
VENNESSA PETROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10209 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9782
(800) 813-2000
Mailing address
15680 SE MONNER RD, HAPPY VALLEY, OR 97086-5813
(509) 539-4852
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
OR
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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