Individual
PETRA NIHAD BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
(614) 688-3763
Mailing address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
RES.004349
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2021
Last updated
05/18/2022
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