=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366591422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALPHONSO PEEPLES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 05/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 SO CHERRY RD
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-329-3636
-----------------------------------------------------
Fax | 803-817-1785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 188
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29731-6188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-329-3636
-----------------------------------------------------
Fax | 803-817-1785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2678
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------