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General NPI Number Information
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NPI Number | 1003809773
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Entity Type | Individual
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Provider Name | YAOHSIEN PENG DDS
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 14 GALLIVAN LN
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City | UNCASVILLE
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State | CT
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Zip | 06382-1208
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Country | US
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Telephone | 860-389-3148
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Fax | 860-367-0668
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Provider Business Mailing Address
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Address Line | 14 GALLIVAN LN
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City | UNCASVILLE
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State | CT
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Zip | 06382-1208
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Country | US
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Telephone | 860-367-0688
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Fax | 860-367-0668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 048520-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 009652
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License Number State | CT
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