Provider Demographics
NPI:1871754721
Name:PETRISOR, CAMELIA (DDS)
Entity type:Individual
Prefix:DR
First Name:CAMELIA
Middle Name:
Last Name:PETRISOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAMELIA
Other - Middle Name:
Other - Last Name:SANDULACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26298 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3375
Mailing Address - Country:US
Mailing Address - Phone:586-776-5015
Mailing Address - Fax:
Practice Address - Street 1:26298 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3375
Practice Address - Country:US
Practice Address - Phone:586-776-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197491223G0001X
OH300229381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice