Provider Demographics
NPI:1861410482
Name:PETROL, CANDIDE J (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDIDE
Middle Name:J
Last Name:PETROL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41011 CALIFORNIA OAKS RD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-698-8200
Mailing Address - Fax:951-698-0366
Practice Address - Street 1:41011 CALIFORNIA OAKS RD.
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5751
Practice Address - Country:US
Practice Address - Phone:951-698-8200
Practice Address - Fax:951-698-0366
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics