MEDICARE: AFFINITY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	009652	CT
2	1223P0700X	Prosthodontics	009652	CT

General Provider Information

NPI Number	:	1467780585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY DENTAL

Provider Business Mailing Address
First Line	:	PO BOX 502
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-0502
Country	:	US
Telephone Number	:	860-389-3148
Fax Number	:	860-367-0389

Provider Business Practice Location Address
First Line	:	14 GALLIVAN LN
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-1208
Country	:	US
Telephone Number	:	860-389-6016
Fax Number	:	860-367-0389

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YAOHSIEN PENG
Credential	:	DDS
Telephone Number	:	860-389-3148

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

Similar Medicare Providers

1003809773 — DR. YAOHSIEN PENG DDS
Practice Location Address:

14 GALLIVAN LN
UNCASVILLE, CT
06382-1208

Practice Phone: 860-389-3148
Practice Fax: 860-367-0668

1780660936 — DR. BARBARA PEARL ROOMKIN DMD
Practice Location Address:

14 GALLIVAN LN
UNCASVILLE, CT
06382-1208

Practice Phone: 860-367-0688
Practice Fax: 860-367-0668

1841285988 — MIHKEL J HAUS MD
Practice Location Address:

88 NORWICH NEW LONDON TPKE , SUITE 2
UNCASVILLE, CT
06382-2518

Practice Phone: 860-367-0087
Practice Fax: 860-367-0117

1831184977 — DONALD J FELITTO MD
Practice Location Address:

88 NORWICH NEW LONDON TPKE , SUITE #2
UNCASVILLE, CT
06382-2518

Practice Phone: 860-367-0087
Practice Fax: 860-367-0117

1679568323 — THE MOHEGAN FIRE COMPANY INCORPORATED
Practice Location Address:

2029 NORWICH NEW LONDON TPKE
UNCASVILLE, CT
06382-1330

Practice Phone: 860-848-3004
Practice Fax:

1841285509 — JAY M GINSBERG MD
Practice Location Address:

88 NORWICH NEW LONDON TPKE , SUITE #2
UNCASVILLE, CT
06382-2518

Practice Phone: 860-367-0087
Practice Fax: 860-367-0117

Directions to “AFFINITY DENTAL ” Practice Location

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