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General NPI Number Information
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NPI Number | 1497905509
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Entity Type | Organization
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Legal Business Name | PETER A ROUFF DMD PLLC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 495 DELAWARE ST
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City | TONAWANDA
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State | NY
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Zip | 14150-5348
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Country | US
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Telephone | 716-693-9077
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Fax | 716-693-9243
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Provider Business Mailing Address
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Address Line | 495 DELAWARE ST
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City | TONAWANDA
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State | NY
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Zip | 14150-5348
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Country | US
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Telephone | 716-693-9077
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Fax | 716-693-9243
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Authorized Official
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Title or Position | MEMBER/ORTHODONTIST
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Name | PETRE A ROUFF
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Credential | DMD
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Telephone | 716-693-9077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | NY052405
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License Number State | NY
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