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General NPI Number Information
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NPI Number | 1366532194
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Entity Type | Individual
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Provider Name | PETER TIMOTHY BLISS DMD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 623 MAIN ST
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City | OLEAN
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State | NY
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Zip | 14760-1532
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Country | US
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Telephone | 716-375-7306
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Fax | 716-375-7463
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Provider Business Mailing Address
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Address Line | 623 MAIN ST
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City | OLEAN
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State | NY
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Zip | 14760-1532
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Country | US
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Telephone | 716-375-7306
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Fax | 716-375-7463
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D16672
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 056537
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License Number State | NY
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